“ w^uMENTS DEPOSITORY
Raymond H. Foster Library
University of Main, at Orono
'-rono. Maina 04469
Opinion of George Cooper, Q.C.,
Regarding Canadian Government Funding
of the Allan Memorial Institute
in the 1950’s and 1960’s
The text of the opinion of George Cooper, Q.C., is
available from Communications and Public Affairs,
Department of Justice, Ottawa, Ontario, K1A 0H8,
Opinion released with the authorization of the
Honourable John C. Crosbie, Minister of Justice and
Attorney General of Canada
© Minister of Supply and Services Canada 1986
Cat. No. J2-63/1986
TABLE OF CONTENTS
1. PROCESS: STEPS TAKEN TO LEARN THE FACTS
(INTERVIEWS, REVIEW OF FILES, ETC.) 5.
A . Preliminary 5 .
B. Problems in digging up information
20-40 years old 7 .
C . Limitations to my mandate 8 .
D. General comments on the interview and
file review process 10.
E. Expert opinions 11.
2. PSYCHIATRIC PROCEDURES IN USE AT THE
ALLAN MEMORIAL INSTITUTE FROM 1948-1964 12.
A. General conclusion 12.
B . The intellectual and scientific basis
for the procedures of '^depatterning"
and psychic driving 14.
C. The procedures involved 16.
(1) Depatterning and prolonged sleep 17.
(2) Sensory isolation 18.
(3) Psychic driving 19.
(4) Psychoneurotic and schizophrenic patients 20.
(5) Procedures highly intrusive and intensive 21.
D. The problem of loss of memory 22.
E. Dr. Cameron's assessment of depatterning 23.
F. Psychic Driving - further comments,
ana t)r. Cameron's assessment 25 .
G. The use of drugs - further comments 26.
H. Conclusions on the theoretical basis for
and the efticacy ot Dr. Cameron's procedures 26 .
Pa g . e .
3. INVOLVEMENT OF AGENCIES OR DEPARTMENTS OF THE
GOVERNMENT OF CANADA IN FUNDING THE AMI 29.
A. National Research Council (NRC) as predecessor
to the Medical Research Council ( MRC ) 29 .
(1) No. 290 - Behavioural Laboratory 30.
(2) No. 217 - Reactions of Civilians to
Community Disasters 30.
B. Defence Research Board (DRB) 30.
(1) Introduction 30.
(2) The Korean War and "brainwashing" 31.
(3) Sensory deprivation experiments of
Dr. Donald 0. Hebb 33.
(4) Connection between Hebb's work and
Cameron's work 36.
(5) DRB funding of projects at the Allan 37.
C. Department of National Health and
Welfare ("H&W") 38.
(1) Introduction 38.
(2) The form and manner of applying for a
grant under the Mental Health Grant 39.
(3) Grants to the Allan Memorial Institute 41.
(a) Project No. 604-5-14 43.
(b) Project No. 604-5-432 43.
(4) The method of dealing with Dr. Cameron's
grant applications 46.
(5) Progress Monitoring 48.
( 6 ) Conclusions 50.
4. THE CLIMATE OF THE TIMES 51 .
A. The background to the National Health 51 .
B. Some Background Data 52.
C. The state of psychiatry and the growth
in research after 1948
5. THE PERSONALITY, CHARACTER, AND PROFESSIONAL
ACTIVITIES OF DR. D. EWEN CAMERON, AND AN
ASSESSMENT OF THE QUALITY OF HIS WORK 57.
A . Persona 1 i t y, character and professional
a c t i v i ties 5 7 .
B . An asse s sment of Came ron ' s_ abilities as a
research scientist ~ 63.
(1) General conclusion 63.
(2) The Hawthorne and placebo effects 64.
(3) The background for the general conclusion
on Dr. Cameron's abilities as a research
scientist 68 .
(4) Reservations of psychologists 69.
C. Conclusio ns on the qua li ty of Dr. Cameron's
work ahB~~its~ place in the context of the times 70.
D . Knowledge held by H&W employees as to the
quality of t)r. Cameron's research 74 .
E . Concl usion on the efficacy and propriety of
reservations ’ 75 .
(1) Dr. Omond Sol and t 76.
(2) Dr. Robert A. Cleghom 79 .
(3) Dr. F.C. Rhodes Chalke 82.
(4) Dr. Charles A. Roberts 82.
(5) Mr. John Osborne 83.
( 6 ) Dr. Craig Mooney, and
Dr. J.W. Fisher 83.
(7) Sir Aubrey Lewis 85.
6 . ETHICAL CONSIDERATIONS SURROUNDING THE
NATURE AND QUALITY OF DR. CAMERON'S
ACTIVITIES, AND THE ISSUE OF PATIENT CONSENT 86 .
A . Ethical standards in medical research
and experimentation 8 6 .
B. The question of consent 90 .
C . Some developments subsequent to
br. Cameron^ s tenure at the Allan in
the matters ot consent and choice of
treatment 91 .
(1) The Halushka Case 92.
(2) The "Patient's Rights" Movement 92.
(3) The Helsinki Declaration 93.
(4) Dr. Edmund Pellegrino 93.
(5) Thalidomide 94.
7. THE INVOLVEMENT OF THE CIA 95.
A. General conclusion 95.
B. The context of the times 97.
C. Understanding between Canada and the U.S. 97.
D. The Society for the Investigation
ot Human Ecology 100 .
E. Dr. Cameron's grant application to the SIHE 102.
F. The position of the U.S. government 103.
G. The CIA and Dr. Cameron's research activities 103.
H. Conclusions 112.
8. THE OKLIKOW AND MORROW CASES 113.
A. The Orlikow case 114.
B. The Morrow case 115.
9. LEGAL PRINCIPLES APPLICABLE TO THIS CASE,
AND CONCLUSIONS OF LAW 117.
A. Preliminary assumption 117.
B. Legal analysis 118.
C. Conclusion 122.
D. Limitation of Actions or Prescription 122.
E. Civil Law 123.
10. THE WIDER RESPONSIBILITIES OF GOVERNMENT 123.
A . Further discussion of the "penultimate
question" - whether Dr. Cameron 'T
treatments were proper or improper 123 .
B. The "ultimate" question — the Crown's
r e spon sl b ll ty 125 .
11. FINAL CONCLUSIONS 127.
LIST OF APPENDICES 129.
MclNNES COOPER 8 c ROBERTSON
BARRISTERS A SOLICITORS
TELEPHONE AREA CODE 902
CABLE ADDRESS “Mclnnes"
Donald Mclnnes. Q C
Harold F Jackson. O C.
Harry E Wrsthall. Q C
Lawrence J Hayes, QC
John Q. Cooper. O C
James E. Gould
Linda Lee Oland
Harvey L Morrison
Thomas E. Hart
Peter M S. Bryson
Marcia L. Ruitenberg
Deborah K Smith
John H Dickey O C
George B Robertson. Q C.
Reginald A Cluney. O.C.
John M Davison. Q C
Joseph A F Macdonald. O I
David B Ritcey. O.C.
David H Reardon. O.C
Robert G Belliveau
W Wylie Spicer
John D Stringer
Gregory J Arsenault
Brian G Johnston
K Sara Filbee
Scott C Norton
Fae J Shaw
Lewis A Bell. Q.C.
Hector Mclnnes. O.C.
Stewart Mclnnes. O.C
George T H Cooper. Q C.
Peter J E. McDonough. Q C.
George W MacDonald
Michael I King
F V.W Panic**
Christopher C Robinson
Nicholas A Pittas
David A Graves
Gregory H Crosby
John G Robinson
P.O BOX 730
1673 BEDFORD ROW
May 3, 1986
Dear Mr. Crosbie,
Re: Allan Memorial Institute
Officials of your department advised me a few
days ago of your intention to make public my opinion trans-
mitted to you on March 7, 1986. Because of my undertaking
to those whom I interviewed in the course of preparing my
opinion, to the effect that their names would not be
publicly linked with particular passages in my opinion with-
out their consent, I thought it best to speak to all those
I am happy to report that in every case, I
have received their consent. In the course of reviewing the
particular passages with them, I have incorporated a small
number of changes in the text of the opinion. All of these
changes are of an editorial nature and none of them alter in
any way the substance of what I had been told, or my con-
Yours very truly.
Honourable John C. Crosbie,
P.C., Q.C., M.P.,
Minister of Justice,
House of Commons,
Room 418 N, Centre Block,
K 1 A 0A6
MclNNES COOPER & ROBERTSON
BARRISTERS A SOLICITORS
TELEPHONE AREA CODE 902
Donald Mcmnaa. 0 C.
Harold F Jackaon QC
Harry E WirattaJt. QC
Joaaph AF MacdonaML O.C
Oavtd B Rrtcay. Q C
David H. Haardon. Q.C.
AotartO Bakivaa d
John 0. Sarmgar
Qragory J. Araanau*
Bnan a Johnston
K. Sara Filbaa
John Q. RoOmaon
Mauraan E Rato
Gaorga 6 RoOartaon. OC.
Reginald A CJunay. O.C
John M. Dav«aon. Q.C
Gaorga T.H. Cooper. Q.C.
Pater J.E McDonough. O.C
Gaorga At MacOonakJ
Michael L King
Chnatophar C. RoOmaon
Nicholaa A Pittas
Oavkj A Gravaa
Marda L Ruitanbarg
Deborah K. Smith
Lewis A Bail. O.C
Hector Mctnnei O.C
Lawrence J. Hayes. Q C
John C Cooper. Q.C
Jamas E Gould
Unda Lee dand
Harvey L Momson
Thomas E Hart
Peter M S. Bryson
Scott C. Norton
Fee J. Shaw
KL Li 1
R E » * i
CABLE AOORESS “Mclnnes"
PO BOX 730
1673 BEDFORD ROW
OUR FILE: G“1891
MarcJh 7, 1986
John H Dickey, Q.C
Dear Mr. Crosbie,
Re : Allan Memorial Institute
I transmit herewith my opinion on this matter.
Upon undertaking this assignment, I and officials
of your Department determined that this opinion would
be subject to the usual solicitor-client privilege. On
this understanding, and following discussions on the point
with these officials, I gave assurances of confidentiality
on behalf of the Department to all those whom I interviewed
for purposes of ascertaining the facts on which my con-
clusions are based. I express the hope that this under-
taking will be fulfilled.
Should there be anything further I can do in
connection with this matter, by way of clarification or
otherwise, I am of course at your disposal.
P.C. , Q.C. , M.P. ,
Minister of Justice,
House of Commons ,
Room 418 N, Centre Block,
Ottawa , Canada
MclNNES COOPER ft ROBERTSON
BARRISTERS & SOLICITORS
TELEPHONE AREA CODE 902
CABLE ADDRESS “Mdnne*"
Donald Mclnnes. Q C
Harold F Jackson. QC
Harry E Wrathall. 0 C
Joseph AF Macdonald. Q C
David a Ritcey. Q.C
David H Reardon. Q.C.
Robert G Belliveau
W Wylie Spicer
John D Stringer
Gregory J Arsenault
Brian G Johnston
K Sara Filbee
John G Robmson
Maureen E Re»d
George B Robertson. Q.C
Reginald A Cluney. Q.C
John M Davison. Q C
George T.H Cooper. Q.C
Petvrr J E. McDonough. Q C.
George W MacDonald. Q C.
Michael L King
Chnstopher C Robinson
Nicholas A Pittas
David A Graves
Marcia L Ruitenberg
Deborah K. Smith
John H Dickey. Q.C
Lewis A Bell. Q.C
Hector Mclnnes, Q C
Lawrence J Hayes. Q C
John G Cooper Q C.
James E Gould Q C
Linda Lee 01. md
Harvey L Morrison
Thomas E Hart
Peter M S Bryson
Scott C Norton
PO BOX 730
1673 BEDFORD ROW
February 26, 1986
The Honourable John Crosbie, P.C. M.P.
Minister of Justice and
Attorney General of Canada
K1 A 0H8
Dear Mr. Crosbie:
You have asked for my opinion on certain matters related
to activities carried on at the Allan Memorial Institute
("AMI") in Montreal during the 1950's and 1960's by Dr.
D. Ewen Cameron and others, and in particular as to
whether in the funding of these activities the Government
of Canada did anything or omitted to do anything which
might be found to be illegal or improper if an action were
brought or a complaint made by one or more former patients
at the AMI
In December, 1980, nine former patients at the AMI brought
action against the U.S. Government, claiming damages for in-
juries suffered by them while under the charge of the AMI
and particularly Dr. Cameron. They allege that the Central
Intelligence Agency (CIA) funded Dr. Cameron to perform psy-
chiatric "experiments" on them without their consent, resul-
ting in permanent injury. The specific techniques or proce-
dures alleged are massive electro-shocks, psychic driving,
drug-induced sleep and the use of controversial chemicals
such as lysergic acid diethylamide (LSD). These allegations
form the backdrop of publicity and public concern against
which my review of the facts underlying this opinion has
taken place. The Second Amended Complaint of the nine
plaintiffs is attached as Appendix 1 . A letter from the
plaintiffs' attorney plus enclosures, which sets out the
basis of this claim, is attached at Appendix 1A.
As a result of discussions with J.C. Tait, Q.C., Assistant
Deputy Minister, Public Law, and M.L. Jewett, Q.C., General
Counsel, Constitutional and International Law, I understand
you are seeking both an opinion as to the government's po-
tential legal liability, and also an opinion as to whether
the government may be under some duty towards the patients
of a kind which falls short of legal liability; and, if so,
what kind of response might be made by the government to
discharge such moral responsibility. This opinion addresses
My plan will be to address the following points:
(1) the steps I have taken to learn the facts;
(2) conclusions as to what psychiatric procedures were
actually used at the AMI under Dr. Cameron and his
(3) the involvement of agencies or departments of the
Federal Government in funding the AMI;
(4) the climate of the times during which the work of
Dr. Cameron and his associates was carried out;
(5) the personality, character and professional
activities of Dr. Cameron, and an assessment of the
quality of his work;
(6) a discussion of the ethical considerations
surrounding the nature and quality of scientific and
medical research and experimentation in the 1950's
and early 1960's, both generally and in relation to
Dr. Cameron's work, and a comparison with today's
(7) the involvement of the Central Intelligence Agency
(8) a discussion of the lawsuits conducted in the Quebec
Superior Court in connection with this matter
( Orlikow v. The Royal Victoria Hospital and Morrow
v. The Royal Victoria Hospital ) ;
(9) a discussion of the legal principles which apply to
this case, and conclusions of law;
(10) a discussion of the wider responsibility of the
(11) final conclusions.
I have been assisted throughout by Louis B.Z. Davis of the
Constitutional and International Law Section of the
Department and by Mr. Ron Louisseize, Legal Assistant in
the Civil Litigation Section, as well as by members of my
firm. The help of all these people has been invaluable.
I have also been assisted by Dr. G.L. Nelms, Associate
Chief, Research and Development, Department of National
Defence; by Dr. Ron Heacock, Director General, Extra-Mural
Research Programs Directorate, Health Services and
Protection Branch, Department of Health & Welfare; and by
Mr. Brian Dickson, Director, Legal Advisory Division,
Bureau of Legal Affairs, Department of External Affairs,
together with others in each of those Departments. In
particular, I have met with J.H. Taylor, Under-Secretary
of State for External Affairs; D.B. Dewar, Deputy
Minister of the Department of National Defence; and David
Kirkwood, Deputy Minister of the Department of Health and
Welfare. From all of these individuals I have received
the fullest cooperation.
1. PROCESS: STEPS TAKEN TO LEARN THE FACTS
(INTERVIEWS, REVIEW OF FILES, ETC.)
A preliminary word on the scope of my inquiries is in
In your letter of July 26, 1985 and in Mr. Jewett's letter
of July 29, 1985 your instructions made no specific refer-
ence to Dr. Cameron. In this opinion I have, however,
concentrated on Dr. Cameron for a number of reasons.
First, he was the head of the AMI at all relevant times,
and its driving force. It was he more than anyone else
who developed the psychiatric procedures now in controver-
sy, and he was clearly the leader in their application to
Second, in the actions of the nine U.S. plaintiffs, two of
whom also brought action in Quebec (Mrs. Velma Orlikow and
Dr. Mary Morrow), Dr. Cameron appears to be singled out as
the "guilty party"; indeed in the Morrow case his estate
was named as a defendant.
Third, in the course of reviewing the facts necessary for
purposes of this opinion, I have seen considerable mater-
ial relating to the work of Dr. Cameron's colleagues at
the AMI, material that in my opinion is sufficient to give
a clear picture of the psychiatric work that was carried
on there. In accordance with usual academic practice, a
number of colleagues - professors, residents and those
from other disciplines - were often associated together in
the same piece of research; usually the names of two or
more would appear as contributors to the published re-
sults. Thus, although I have not made special inquiries
about, or searched for all file material held by govern-
ment departments or by the Public Archives on, each of
Dr. Cameron's associates - that task would have taken con-
siderably more time - I have searched high and wide for
information on Dr. Cameron; and in so doing, I believe I
have a clear, if not an absolutely complete, picture of
the work of his associates as well, at least in the
relevant subject area.
B. Problems in digging up information 20-40 years old
The events in question began to take place at the AMI over
thirty-five years ago. Three important consequences flow
from this fact. First, many of the routine administrative
files in the two key departments (Health & Welfare and
National Defence) have been destroyed in the ordinary
course, with the result that I have had to rely a great
deal upon the recollection of those who were directly in-
volved at the time. Second, some of those who were
directly involved have since died, with the result that
the record is necessarily incomplete in so far as it
depends upon recollections. Third, many of those still
living could not be of assistance on points of detail,
simply because their recollections are no longer precise
in view of the time that has passed since they were
actively involved with the subject.
Nevertheless, I am persuaded that enough factual material
has been uncovered, both in direct interviews and from the
files that still exist, to allow factual conclusions to be
drawn with a high degree of certainty. There is, of
course, the possibility that new facts might come to
light, either from government file material not yet un-
covered, or from individuals now or formerly in the public
service who might come forward with new information, but I
consider this possibility to be remote. Consequently, I
believe I have seen and heard sufficient to conclude that
all of the important facts that could now be known about
this subject, and which are in the possession of the
Government of Canada or any of its departments, agencies
or employees (past or present), are now known and have
been taken into account for purposes of this opinion; and
that it is unlikely that new facts of strong probative
value will later be uncovered.
C . Limitations to my mandate
This conclusion is of course subject (as is the whole of
this opinion) to the important qualification that the
scope of my inquiries has been limited by the terms of
reference stated in both your letter of July 26, 1985 and
Mr. Jewett's letter of July 29, 1985. In accordance with
that mandate, and apart from consultations with the three
independent experts referred to later, I have confined my
interviews to people having a past or present connection
with the Government. Similarly, I have confined my file
search to files in the possession of the Government
(except that I have also reviewed the files publicly
available in the Quebec Superior Court in the case of
Orlikow v. The Royal Victoria Hospital (case no.
500-05-006872-798), and in the Quebec Superior Court (case
no. 500-05-738532) and in the Quebec Court of Appeal (case
no. 500-09-001247-782) in the case of Morrow v. The Royal
Victoria Hospital ). I have not made any inquiries of peo-
ple who do not have such a connection, nor (except as
noted) have I seen any files in the possession of people
or institutions other than the Federal Government.
Thus, I have made no enquiries of (for example) former
patients or staff at the AMI at the time when Dr. Cameron
was there, and it is of course possible that new facts
might come to light from that source. (As discussed fully
later, I did interview Dr. Robert A. Cleghorn at length
and received very valuable information from him; Dr.
Cleghorn was a psychiatrist on staff at the AMI, and
succeeded Dr. Cameron as Director of the Institute in
1964. I was able to speak to Dr. Cleghorn, not on the
basis of his association with the AMI, but because of his
association with the Defence Research Board where, for a
period prior to 1961, he was Chairman of the Panel on
Psychiatric Research of the Medical Advisory Committee of
the Defence Research Board.) I have seen no medical
records of patients at the Allan. Finally, I have not had
access to material from the CIA or other U.S. sources,
except as specifically referred to in this opinion.
D. General comments on the interview and
file review process
Because of the fact that so much file material has been
lost, I felt it important to interview former government
employees and also certain people formerly associated with
research advisory panels but not in the employ of the
Government. I was also given complete freedom by the four
Departments involved to speak to those still employed in
the public service. As a result, I have personally spoken
to all present and former members of the public service
still living who had anything substantial to do with any
of the Government research grants programs in the mental
health field. In every single case, both present and re-
tired members of the public service were willing to talk
at length and without reservation to me, and I have taken
extensive notes of these conversations. In no case have I
detected any element of reserve or lack of cooperation. I
have detected no attempt to hide or gloss over any aspect
of the questions at issue, and never any attempt to mis-
I should add that I gave assurances to those whom I inter-
viewed that their comments would not be publicly attri-
buted to them without their consent.
I was also given complete freedom to review all of the
files still available at the Departments in question
(Justice, External Affairs, Health & Welfare and Defence)
and at the Public Archives of Canada, and this includes
files which appeared on the surface to be only marginally
relevant and which, on closer examination, proved to yield
no information of any probative value. I have completed
such reviews. The Department of Veterans Affairs and the
Medical Research Council also assisted by reviewing their
files and I am satisfied that these bodies did not fund
any projects of Dr. Cameron except for one or possibly two
projects as discussed in section 3 of this opinion. I did
not review any cabinet documents, and I have no reason to
believe they would yield any fruitful information.
A list of those whom I interviewed is attached as Appendix
2, and a list of the files which I reviewed is attached as
E . Expert opinions
I have had the benefit of expert opinions from Dr.
Frederic Grunberg , Professor of Psychiatry at the
University of Montreal (and incidentally the current
President of the Canadian Psychiatric Association) , Dr.
Ian McDonald, Dean of Medicine at the University of
Saskatchewan, and Dr. Fred Lowy, Dean of Medicine at the
University of Toronto. Their expert opinions and
curricula vitae are attached as Appendices 4, 5, and 6
2. PSYCHIATRIC PROCEDURES IN USE AT THE
ALLAN MEMORIAL INSTITUTE FROM 1948-1964
A. General conclusion
It is clear that the techniques and procedures alleged by
the nine plaintiffs in the U.S. law suit were in fact used
at the AMI, and by Dr. Cameron in particular. That is to
say, each of the techniques of Electro Convulsive Therapy
(ECT, sometimes known as Electric Shock Therapy), includ-
ing massive electric shocks ( "depatterning" ) ; sleep thera-
py; partial sensory isolation; psychic driving; and
psychopharmacology (drugs) were used. Most important of
these was the procedure called by some "Regressive Shock
Therapy" ( RST ) , and called by Dr. Cameron "depatterning",
which is perhaps the most controversial of all.
In stating this conclusion, it will be appreciated that I
am making no judgment as to the accuracy of any particular
plaintiff's claim about the use of any one or more of
these techniques in his or her case, as to the appro-
priateness of that technique in relation to that parti-
cular plaintiff's illness, or as to whether, in any
particular case, the treatment was applied in a proper
fashion. In accordance with my mandate, I did not address
any of these issues. The point is simply that there is no
doubt that Dr. Cameron used all of these techniques at
various times, and it is certainly within the realm of
possibility that the plaintiffs received all the treat-
ments they allege they have received.
The psychiatric treatments administered at the Allan at
various times during the 1940's, 1950's and 1960's may for
present purposes be divided into two categories:
(1) those in use elsewhere in Canada and the world;
these included EOT (electro convulsive therapy,
sometimes called electroshock therapy) , insulin
coma shock therapy, sleep therapy and drugs
(including lysergic acid diethylamide, or LSD);
(2) those in use at the Allan and at a few centres
in some other countries (but not elsewhere in
Canada); these included depatterning , psychic
driving and sensory isolation.
None of the foregoing psychiatric procedures were pioneer-
ed at the Allan, and none were unique to it, though the
procedures of psychic driving and depatterning were devel-
oped further and continued longer at the Allan than else-
where. Moreover, the use in combination of the techniques
of depatterning, psychic driving, sensory isolation, sleep
therapy and drugs appears to be unique to the Allan.
A general discussion of the theoretical basis for these
treatments follows in paragraph B., and a description of
the actual procedures involved follows at paragraph C.
Formal descriptions are found in articles published by
Dr. Cameron in the scientific literature and attached as
Appendices 7 to 1 7 inclusive.
B. The intellectual and scientific basis for the
procedures of "depatterning” and psychic driving
Dr. Cameron held the view that mental illness was the con-
sequence of the patient's having learned over the years
"incorrect" ways of responding to the world around him or
The "brain pathways" had thus developed through repetition
a set of "learned responses" that were not socially
acceptable and resulted in the patient's being classified
as mentally ill.
It had been observed over many years by psychiatrists that
persons who were subject to convulsions of the brain did
not become mentally ill. Examples are those who suffer
from epileptic convulsions, and those who suffer from
insulin coma. It was speculated that these naturally
occurring convulsions somehow cleared the "brain pathways"
and thus eliminated these "incorrect" thought processes.
From these observations it was deduced that if convulsions
could be applied artificially to mentally ill patients.
the "brain pathways" would be broken up and the patient's
illness would be relieved. This was the fundamental idea
behind ECT, insulin coma shock therapy and other therapies
designed to induce convulsions.
Dr. Cameron took hold of this idea and developed it much
further than psychiatrists in the mainstream of European
and North American practice. His idea was to break up the
brain pathways through the highly disruptive application
of massive electroshocks, many times the number of shocks
in a normal ECT treatment - two times a day, as opposed to
three times a week, for example - until the patient's
brain had been "depatterned" ; i.e. (in the case of
psychotic patients) until all schizophrenic symptoms were
lost, as well as other aspects of memory. After this had
occurred, the idea was then to "re-pattern" the brain by
trying to instill new and "correct" patterns of thinking
in the patient's mind.
Under Cameron's theory, one might compare the patient's
brain to an old-fashioned telephone switchboard, in which
all the wires were plugged into the wrong holes. In
depatterning , all the wires were pulled out; in
repatterning, the aim was to plug all the wires back into
the right holes.
A second theoretical basis upon which these procedures
rested was the idea that serious mental illness was the
result of poor mothering, an idea developed in the U.K. in
the 1930's and 1940's. If a child could be "re-mothered"
by a procedure known as "anaclitic therapy", it could be
cured of the illness. Dr. Cameron in effect applied this
idea to adults. Through "depatterning" , he had reduced
the patient's mind to a childlike state; through re-
patterning, his idea was to "remother" the patient in the
protected and kindly environment of the hospital. Psychic
driving was one of the techniques of remothering.
Dr. Cameron used these two procedures of depatterning and
psychic driving in treating both psychotic patients
(schizophrenics) and psycho-neurotic patients. It is
important to note that, with respect to selection of
patients in the psychoneurotic category, he said:
"With regard to selection , we select primarily
chronic psychoneurotic patients in whom all previous
forms of therapy have failed." (Appendix 14, p. 210)
(emphasis in original)
"The patients selected are almost entirely those
suffering from extremely long-term and intractable
psychoneurotic conditions." (Appendix 18, p. 5)
C. The procedures involved
Following is a brief description of these treatments, in
their most highly developed form and taken in combination
as they sometimes were.
( 1 ) Depatterning and prolonged sleep
In depatterning, the patient would be subjected to massive
electroshock treatments - sometimes up to twenty or thirty
times as intense as the "normal" course of electro
convulsive therapy (ECT) treatments. At the end of up to
30 days of treatment - up to 60 treatments at the rate of
two per day - the patient's mind would be more or less in
a childlike and unconcerned state.
In preparation for the treatment, the patient would be put
into a state of prolonged sleep for a period of about ten
days, using various drugs. At that point, the massive
electroshock therapy would begin, the patient being main-
tained on continuous sleep throughout. Somewhere between
the thirtieth and sixtieth day of sleep, and after 30 to
60 electroshock treatments, depatterning would be
complete. Depatterning was then maintained for about
another week, with electroshocks being reduced to three
Gradually the treatments were reduced to one a week. Then
followed a period of reorganization, when the patient came
back from the "third stage", through the "second stage",
up to the "first stage" of depatterning. During this
period the patient would undergo considerable anxiety; to
control this, the drugs chlorpromazine (Largactil) and
sodium amytal were administered.
The purpose of this procedure, in the case of
psycho-neurotic patients, was to prepare them for a course
of "psychic driving".
(2) Sensory isolation
An alternative method of preparing patients for psychic
driving was to place them in situations of "sensory isola-
tion". This involved depriving them of incoming sensory
stimulation. This procedure grew out of work carried out
in the early 1950's by Dr. Donald 0. Hebb, a psychologist
at McGill, on behalf of the Canadian Defence Research
Board. Cameron's work with sensory isolation was not a
continuation of the Hebb work (as suggested by some of the
media coverage), but was intellectually connected with
it. Hebb's work is discussed more fully in section 3 of
Patients would be placed under conditions of sensory
deprivation for a matter of days, in one case as long as
sixteen days. In some cases, patients who underwent
sensory deprivation without effect were subsequently
placed under sleep and shock therapy as described above.
(3) Psychic driving
Following a course of sensory deprivation, or of sleep and
shock therapy, or both, the patient would then undergo the
"psychic driving” procedure. This consisted of messages
played on tape recorders and repeated thousands of times
to the patients by means of pillow microphones, steno-
graphic headphones, and other methods. The idea was first
of all to deliver a negative signal, designed to get the
patient to confront his or her inadequacies. (For example:
"Gertrude, you don't get along with people. You have
never gotten along with your mother... You have always felt
inadequate and have been jealous of other people"...).
This lasted for a period of about ten days, after which
positive messages would be given for about another 10
days. (For example: "Gertrude, you want to be free
like other women. You are trying to give up manipulating
people by your complaints ... You want other people to
like you ...You want to have confidence.")
The content of the messages was usually determined through
psychological interviews conducted with the patient before
the treatment began ("autopsychic driving"), sometimes
while under the influence of disinhibiting drugs. In some
treatments the messages were based on material developed
by the psychiatrist rather than the patient
Psychic driving would take place for continuous periods of
up to sixteen hours per day. Taken together, the positive
and negative messages might be repeated up to half a
Drugs were used throughout the procedure. Barbiturates,
etc. , were used during the period of prolonged sleep. As
the patient emerged from depatterning, the anxiety that
attended the process was relieved by heavy doses of
Largactyl and sodium amytal. During the psychic driving
procedure, in order to keep the patient receptive to the
messages, injections of curare and beeswax would be
given. LSD was sometimes also administered.
Throughout the procedure, and for a period of up to three
years afterwards, a patient would receive intensive
personal care, both in and out of hospital as required,
from the hospital staff including social workers,
psychiatrists, psychologists and nurses. Further electro-
shocks were administered an average of 65 times during
this three year period.
(4) Psychoneurotic and schizophrenic patients
These procedures were used in treating both psychoneurotic
and schizophrenic illnesses, although the psychic driving
technique appears to have been used chiefly with
psychoneurotic patients. Psychic driving appears not to
have been generally used with schizophrenics, who were
repatterned by hospital staff; they spent weeks bringing
them back to the point where they could lead something of
a normal life. Prolonged memory deficit was a
particularly serious problem for both categories of
(5) Procedures highly intrusive and intensive
It will be appreciated that RST, or depatterning, was a
highly intensive and intrusive procedure. It was deliber-
ately aimed at "breaking up the pathways of the brain" and
thus reducing the brain to an almost infantile state. In
fact. Dr. Cameron describes the three stages of
depatterning as follows:
" In the first stage of disturbance of the space-time
image, there are marked memory deficits but it is
possible for the individual to maintain a space-time
image. In other words, he knows where he is, how
long he has been there and how he got there. In the
second stage , the patient has lost his space-time
image, but clearly feels that there should be one.
He feels anxious and concerned because he cannot tell
where he is and how he got there. In the third
stage , there is not only a loss of the space-time
image but loss of all feeling that should be present.
During this stage the patient may show a variety of
other phenomena, such as loss of a second language or
all knowledge of his marital status. In more
advanced forms, he may be unable to walk without
support, to feed himself, and he may show double
incontinence. At this stage all schizophrenic symp-
tomatology is absent. His communications are brief
and rarely spontaneous, his replies to questions are
in no way conditioned by recollections of the past or
by anticipations of the future. He is completely
free from all emotional disturbance save for a
customary mild euphoria. He lives, as it were, in a
very narrow segment of time and space. All aspects
of his memorial function are severely disturbed. He
cannot well record what is going on around him. He
cannot retrieve data from the past. Recognition or
cue memory is seriously interfered with and his re-
tention span is extremely limited."
(Appendix 15, p. 67 ).( emphasis added)
Other psychiatrists, whose work in RST preceded Dr.
Cameron's and formed the basis for the work at the Allan,
described the state of the patient's mind after RST in
these words (taken from the same article at p. 66):
"Kennedy and Ancell described their patients as being
brought to the level of 4-year-old children.
Rothschild and his co-workers referred to certain of
their organically disorganized patients as being
unable to swallow but able to suck fluid from a
feeding bottle. Glueck reported that his patients
were like helpless infants. They were incontinent in
bladder and bowel and required spoon feeding as well
as tube feeding."
It will be appreciated that these graphic descriptions of
the effects of massive electroshock therapy appeared in
articles published in the open scientific literature.
D. The problem of loss of memory
It is well recognized by psychiatrists that simple ECT
causes in many patients the undesired side effect of
"memory deficit". For example, a patient after undergoing
one treatment (a convulsion for perhaps one minute, fol-
lowed by a half hour or hour of sleep) might temporarily
forget how to put on and tie shoes. However, after one
treatment, memory loss is transitory only. After a normal
course of ECT - say twelve treatments over two or three
weeks - memory might be lost for a couple of weeks or so;
on rare occasions, longer. Hospital personnel are, of
course, trained to help patients put their shoes on, etc.,
in the interval during which the memory is recovering.
After depatterning , prolonged memory loss was not at all
unusual, simply because of the massive nature of the
electroshock applied. All schizophrenic symptoms would be
lost, as well as other aspects of memory. The resulting
amnesia was said by Dr. Cameron to be "differential", in
that amnesia for manifestations of schizophrenia would
remain, while recollections of ordinary life happenings
would return during the repatterning process.
E. Dr. Cameron's assessment of depatterning
Did depatterning work? Dr. Cameron certainly believed it
did . In his published article on schizophrenic patients.
Appendix 15, p. 17, he said:
"With regard to efficiency, the first question to
ask is, 'Does it accomplish what is intended?' The
answer is quite definitely 'Yes'. It has resulted
in a considerable increase in efficiency over the
method of multiple shock therapy as introduced by
Bini and Milligan and modified by subsequent
workers. It represents, moreover, a noteworthy
advance over insulin treatment and over the chemical
therapies. Above all things, the readmission rate
is greatly reduced. At the same time, we must point
to the fact that it calls for a most considerable
expenditure in time and effort and it requires the
development of a team of workers who are highly
skilled . (emphasis added)
"With regard to the detrimental side effects, the
most serious is of course the period of complete
amnesia. We are working upon methods to reduce this
and it is proper to say that while it is a source of
trouble and annoyance to the patient during the
first six months or so following discharge, a
scaffolding of subsequent memories consisting in
what he has been told of events which happened
during the amnestic period gradually takes form."
The underlined passage is important, for reasons discussed
in section 5 of this opinion.
It is well to bear in mind that Cameron was not the first,
nor was he the only, psychiatrist to use depatterning
techniques. Massive electric shock methods were
apparently introduced by Cerletti, Bini and Milligan, for
psychoneurotic patients, and reported in the medical
literature as early as 1946. The method was transferred
to the treatment of schizophrenia by Kennedy and Ancell,
who labelled the treatment (misleadingly, according to
Cameron) "Regressive Shock Therapy" and reported on it as
early as 1948. Cameron cites three other groups who used
the technique, reported in the literature in 1950, 1951
It was in 1955 that Cameron himself decided, in his words,
to "develop the potentialities of this procedure". As
stated above he used the procedure to treat both psycho-
neurotics (see the application to the Society for the
Investigation of Human Ecology, Appendix 18, p.5 and the
articles at Appendices 11, p. 985 and 12, p. 744) and
schizophrenics (see Appendix 15).
F . Psychic Driving - further comments, and Dr.
Although sometimes used in conjunction with depatterning
treatments, psychic driving was used in other situations
as well. As explained, the technique consisted of the
repetition of tape recorded messages, first of a negative
kind designed to make the patient face his/her problem,
and later of a positive kind designed to give the patient
a new self image. During the "positive" period, the
hospital staff would work with the patients to encourage
them to put the new behavioural patterns into practice.
Dr. Cameron considered that:
"Our best results have been with chronic
psychoneurotics - and otherwise untreatable -
patients, usually with a long standing character
neurosis, with an anxiety hysteria or an anxiety
neurosis. With these patients our results have been
increasingly encouraging, and we now consider that
this is the procedure of our choice when faced with
such a case." (Appendix 13, p. 107) (emphasis added)
G. The use of drugs - further comments i
Drugs used included barbiturates (such as sodium amytal),
amphetamines (such as desoxyn) and hallucinogenic drugs <
such as LSD-25 or mescaline. In addition, as part of the \
procedure preparatory to administering massive electro- ,
shock therapy, small doses of curare were administered to j
produce a state of relative immobility to maintain the (
patient in the area of repetition. All these drugs were \
in common use by psychiatrists in Canada in the 1950's and ]
early 1960's. \
Because of the public attention that has been focused on *
LSD, I have added Appendix 19 which will illustrate just |
how widespread was its use. i
H. Conclusions on the theoretical basis for and
the efficacy of Dr. Cameron's procedures
On the theoretical side, it is now clear to psychiatrists
generally that Cameron's depatterning , psychic driving and ,
related procedures were not based on sound principles of ,
science or medicine. Psychiatrists no longer accept the
epileptic/schizophrenia dichotomy; and while there may be
something in the idea that mental illness is the result of
poor mothering, Dr. Cameron pushed the idea much too far
in exploring how it might apply to adults. Even when
judged by the knowledge and standards of the day, it is
now seen that the theoretical foundation for Dr. Cameron's
work was very weak.
On the practical side, and judging by the standards of
today, most psychiatrists would conclude that depatterning
was a failure not only in terms of its efficacy as a
medical treatment, but also in that it represented a level
of assault on the brain that was not justifiable even by
the standards of the time and even in light of the rather
rudimentary level of scientific and medical knowledge of
those days compared to today.
These conclusions are, however, evident only with the
benefit of hindsight; and no medical doctor I spoke to
was prepared to state that Cameron's depatterning
procedures were conducted in disregard of the limits of
acceptable medical practice at the time, or otherwise than
out of desire to benefit the patients involved. These
points will be elaborated in sections 5 and 6 of this
opinion, but for the moment it should be noted that some
doctors felt that, as a man driven to try to find
solutions to the problems of mental illness, both in
general and for particular patients. Dr. Cameron may have
allowed himself subconsciously or unintentionally to go
beyond those bounds with respect to some particular
patients; but this is of course speculation and, to ^
repeat, none of these doctors were prepared to attribute q
any improper motive. C
At the same time some individual doctors had doubts about D
the efficacy of the depatterning and psychic driving a
procedures during Dr. Cameron's tenure at the Allan; in 0
fact these procedures were not free from controversy even a
within the Allan itself. However, these doubts took the
form of "mutterings" . Although everyone at the Allan, and
most psychiatrists in Canada, knew about Cameron's work,
and it was fully described in the open scientific T
literature for all to see, no one spoke out publicly q ,
against it. It is also worthy of note that Cameron's ^
treatments were not used by his colleagues in psychiatric ^
practice in other hospitals in Montreal, including those g
within the McGill teaching hospital system, in spite of *,
Cameron's position as professor of psychiatry. They
tolerated his techniques, but they did not adopt them. C
A discussion of these contemporary doubts will be found in r
section 5 of this opinion.
3. INVOLVEMENT OF AGENCIES OR DEPARTMENTS OF THE
GOVERNMENT OF CANADA IN FUNDING THE AMI
Three agencies of the Government of Canada funded Dr.
Cameron for various projects: the National Research
Council ( NRC ) as predecessor to the Medical Research
Council (MRC), the Defence Research Board (DRB), and the
Department of National Health and Welfare (H&W). The DRB
also funded other relevant research at McGill in the field
of sensory deprivation. The activities of these agencies
are discussed in turn.
A. National Research Council (NRC) as predecessor
to the Medical Research Council (MRC)
The National Research Council, through its Associate
Committee on Medical Research, made a grant to Dr. Cameron
in 1944-1946 to study "psychological aspects of return to
industrial civilian life" after the World War II. The
grant number was M.P. 38, and the grant amounted to $3,000
for each of the two years.
Clearly this grant is *not relevant to the matters under
review in this opinion.
I have discovered a list (attached at Appendix 19A) of
NRC Grants-in-aid for psychiatry, showing two other grants
to Dr. Cameron. They are:
(a) No. 290 - Behavioural Laboratory - f
(b) No. 217 - Reactions of Civilians to i
Community Disasters - $650.00. °
The first is an amount identical to the funding during m
1950/51 from Health and Welfare to Dr. Cameron for Health r
and Welfare's Project No. 604-5-14, "Support for a w
Behavioural Laboratory" (see later). I can find no other &
information on NRC Project No. 290. From the figures, I r
assume that either NRC gave a matching grant during the s
one year in question, or Health and Welfare simply paid s
the money on N.R.C.'s behalf. Nothing of significance c
here turns on this grant.
As for No. 217, Reactions of Civilians to Community
Disasters, this obviously represents a grant supplementary 1
to DRB's grant No. 65 to Cameron (see later). Again, - r
there is no further information in the file, and again, 13
nothing of relevance here turns on this grant. *
B. Defence Research Board ( DRB ) t
The DRB was founded in 1946 as the research arm of the 1
Department of National Defence. Dr. Omond Solandt was the
first Chairman, and he remained Chairman until 1957 when
he was succeeded by Adam Hartley Zimmerman, Sr. (now
deceased). The mandate of the DRB was to engage directly
in research of its own, to contract out for specific items
of research work, and to make grants to independent
researchers, in areas of particular application to the
military. The DRB was not to conduct basic scientific
research, but rather applied research. Included in this
was research in psychiatry and psychology, primarily to
develop methods of testing the capabilities of potential
recruits and serving personnel, to determine their
suitability to withstand the stress of combat, and to
study the effect of stress generally in the trying
conditions of war and other emergencies.
(2) The Korean War and "brainwashing"
In the early 1950's there was great concern in the senior
ranks of the military in Canada, United States and the
United Kingdom about the new "brainwashing" techniques
then being used by communist forces during the Korean
War. Troops from these three countries who were captured
during battle were sometimes subjected to these techniques
and as a result were forced to make public statements, or
"confessions", in which they renounced the beliefs and
values of their own country and then espoused publicly
those of the adversary. In certain cases there appeared
to be no physical coercion which could have accounted for se
this behaviour, and often the confessions seemed to be on
quite voluntary and genuine. Reports came back as to the
way in which these confessions were extracted; troops had
been subjected to long spells of isolation, followed by
periods of indoctrination to the new beliefs. One such gh
report is attached as Appendix 20. These techniques gave i n
rise to real concern on the part of the western allies He
that the communists had discovered some new way of con- <rt
trolling the mind. They concluded that it was essential p t
to find out everything that could be learned about these
methods, so that our troops could be told in advance of b<
communist techniques and, to the extent possible, trained ■)<
to withstand brainwashing. M<
A high-level meeting took place at the Ritz Carlton Hotel p
in Montreal on June 1, 1951 to discuss the problem. c
Present were representatives of the scientific research m
establishments of the Canadian, the U.S. and the U.K. t
military. Dr. Solandt was Canada's chief representative. b
Dr. Donald 0. Hebb, a psychologist from McGill University, t
was also present and proposed to the group that experi- s
ments in "sensory deprivation" might be carried out to b
determine whether something of the communists' brain- t
washing techniques might be learned. Attached at Appendix c
21 is a copy of the minutes of the June 1, 1951 meeting; \
the handwritten note appended to these minutes (found f
separately in DRB files) suggests that Commander Williams,
one of those in attendance, was with the CIA.
(3) Sensory deprivation experiments of
Dr. Donald 0. Hebb
Shortly after the meeting of June 1, 1951, the DRB entered
into a contract (designated the X-38 Project) with Dr.
Hebb to conduct these "sensory deprivation experiments".
The purpose of the work was to establish whether indeed
prolonged periods of sensory deprivation reduces the sub-
ject's resistance to accepting new beliefs contrary to
beliefs previously held. The work continued from 1951 to
1955 and involved some 63 paid volunteers, students from
Dr. Hebb's practice was to place his subjects in a small
cubicle in which external stimulae were kept to a
minimum. The forearms would be covered with cardboard
tubing, cotton wool would cover the hands, glasses would
be worn which permitted only diffused light to enter, and
there would be no auditory stimulation. The student would
spend as much time in this situation as could reasonably
be accepted, and was free to leave at any time. While in
this state of sensory deprivation, the subject would be
offered the opportunity of hearing material distasteful to
him or her, through gramophone recordings. An extract
from some of Hebb's earliest work will illuminate the
"Three gramophone recordings were available to the
subject, all with material the subject found unplea-
sant at the beginning of the experiment: (1) four
repetitions of 16 bars from "Home on the Range"; (2)
a 5-min. extract from a harsh atonal piece of music;
and (3) an excerpt from an essay instructing and
exhorting young children on the methods and desir-
ability of attaining purity of soul. S could signal
for any of these three. He signalled 42 times alto-
gether, and spent a total time, listening to this
material, of 2 hours and 21 minutes out of his 8$
waking hours. He was mostly unselective in his
choice, usually requesting all three, one after
another, and then, after a pause, going through them
again. The only sign of preference was for (1)
repeated bars from "Home on the Range". This subject
is a college student, in the superior adult class
intellectually, and this is not the kind of material
that would be in any way entertaining to him. As
noted above, he disliked the material to begin with,
and reported that he still disliked it when the
experiment was over."
Alternatively, the researcher might feed to the student
a line of "propaganda" contrary to his or her own beliefs,
to see if he could get the student to espouse that
belief. The beliefs in question were quite innocuous -
for example, a belief in the biblical account of creation,
or a teetotaller's view. At Appendix 22 are copies of
some DRB file materials on this research.
Although the work carried out by Dr. Hebb was originally
classified, it has long since been declassified. Through-
out most of the period when the work was being done, Dr.
Hebb himself repeatedly implored the DRB to allow him to
publish it. He also believed that failure to do so would
result in the public getting the wrong impression when the
material did eventually leak out, as it inevitably would.
Attached at Appendix 23 are some file materials, news
clippings and correspondence which make the point well.
The conclusions reached by Dr. Hebb and his associates may
be simply stated. A changing sensory environment is abso-
lutely essential to the good health of the mind. Without
it, the brain ceases to function in an adequate way, and
abnormalities of behaviour develop; for example, the sub-
ject quickly begins to hallucinate. By "softening up"
a prisoner through the use of sensory isolation techni-
ques, a captor is indeed able to bring about a state of
mind in which the prisoner is receptive to the implanta-
tion of ideas contrary to previously held beliefs. At
Appendix 24 is a three page summary of these results pre-
pared by DRB for Treasury Board on August 3, 1954.
Dr. Hebb, who died in August of 1985, was Canada's fore-
most psychologist, and the author of the seminal textbook.
The Organization of Behaviour (1949). He was regarded as
a very fine scientist and a humane and thoughtful person.
He conducted his research with the highest regard for the
welfare of the volunteer students. I have heard no sug-
gestion of any impropriety in the conduct of his
research. One person told me of an unconfirmed report
that one student developed a form of mental illness
following the experiment, but the suggestion is that the
illness was incipient in any event, and would have
resulted regardless of Dr. Hebb's experiments.
As predicted by Dr. Hebb, his work did eventually leak out
and become the subject of adverse press comment. As a re-
sult, Dr. Solandt was asked for an explanation, and then
required to phase out the research. Appendices 23 and 24
give the background to this aspect of the matter.
(4) Connection between Hebb's work and
Dr. Hebb's work is mentioned in this opinion because some
media reports, and some members of the public who have
written to the government to express concern about Dr.
Cameron's work, have referred to Hebb's work evidently in
the belief that there was a close connection between the
work of the two men. Dr. Cameron, being in close physical
proximity to Dr. Hebb, was, of course, aware of Hebb's
work and was himself interested in sensory deprivation
from a psychiatric perspective. This is made clear in
Hebb's letter of January 1, 1953 in Appendix 23^ So were
others at the AMI, as is shown by the letter from Dr.
Cormier attached as Appendix 25. However, as stated
earlier, the work of Drs. Cameron and Hebb are connected
only in an intellectual sense; Cameron's work was not at
all a . continuation or an elaboration of Hebb's work.
Cameron was often stimulated by the work of other
scientists in related or even unrelated fields, and
sensory deprivation was just one of the new research ateas
in which he took an interest.
Hebb himself was contemptuous of Dr. Cameron's work in the
field of sensory deprivation ( as well as his work in
psychic driving), so I was told by a number of the people
I interviewed. In Hebb's opinion, Dr. Cameron did not
have the necessary background in the principles and
techniques of scientific investigation to understand
properly how (if at all) Hebb's work in sensory isolation
could be utilized in the treatment of patients. The
question of Dr. Cameron's abilities as a research
scientist is discussed fully in section 5 of this opinion.
(5) DRB funding of projects at the Allan
The DRB funded two research projects of Dr. Cameron.
However, neither of these projects were related to the
treatment of mental patients. The two projects in
question (DRB grant Nos. 65 and 172 respectively) were
entitled "Management of Fear and Anxiety by Civilians in
the Event of a Community Disaster" (1948-1951) and
"Behavioural Problems in the Adaptation of White Man to
the Arctic". For an important reason discussed in section
5 of this opinion, the Chairman of the DRB, Dr. Solandt,
ensured that Cameron made no applications to the DRB for Me
work in the area of psychiatric research dealing with HS
The DRB funded a considerable number of other research
projects at the Allan, projects conducted by associates of Tl
Dr. Cameron. I have coincidentally examined quite a lot d]
of file material relating to these projects; none of it
bears on the issues under review in this opinion. I have
not considered it necessary to look further for DRB
funding of psychiatric research involving patients at the
Allan, for two reasons: first, in so far as Dr. Cameron is T1
concerned, as mentioned above the DRB at Dr. Solandt's m.
direction declined to consider any application that might Gi
be made; second, in so far as others at the Allan are v,
concerned, I have no reason to believe that they would f<
apply for, or receive, grants in the fields of activity
under review here (namely depatterning , psychic driving
etc.), which were peculiarly Dr. Cameron's fields.
C . Department of National Health and Welfare ("H&W")
( 1 ) Introduction
In 1948 the federal government established the National
Health Grants program to provide funds for health care in
ten (later, thirteen) health areas. One of these was the
Mental Health Grant. Research grants made to the Allan by
H&W during the period under review (from 1948 to 1964,
when Dr. Cameron left the Allan) were made under this
Mental Health Grant.
The background of the National Health Grants program is
discussed in section 4 of this opinion.
(2) The form and manner of applying for a
grant under the Mental Health Grant
Throughout the period with which we are concerned, the
manner in which grant applications under the Mental Health
Grant were handled was as follows (see Appendix 26 for
various departmental memoranda and a sample application
(a) The institution (e.g. the AMI) would make an
application in the form required by H&W, and
then submit the application to the
(b) The provincial authorities would then
signify their approval of the application by
forwarding it to H&W in Ottawa.
(c) H&W officials would review the application
in a preliminary way to satisfy themselves
generally as to the scientific and medical
adequacy of the proposed research, and to
ensure that all formalities had been
(d) The application would then be referred to
two outside experts in the particular field
of the proposed research. These experts
would give detailed written commentary back
to the Department. The comments would at
all times remain anonymous.
(e) The Research Subcommittee of the Mental
Health Advisory Committee would review each
application to ensure its scientific and
medical adequacy. The Mental Health
Advisory Committee numbered about twenty.
It was composed of experts drawn from
outside the public service and involved in
the disciplines of psychiatry, psychology
and related fields. People from within the
Department would sit as chairman and
secretary of the committee to provide the
necessary liaison. The committee therefore
acted as a form of peer review.
(f) The Subcommittee would report its
recommendations to the full Advisory
Committee, who would then report to
(g) Departmental officials would then recommend
the grants to the Minister, who would then
send his approval back to the province.
(h) The provincial officials would then approve
the grant directly to the institution.
(3) Grants to the Allan Memorial Institute
I turn now to discuss the grants for psychiatric research
made under the Mental Health Grant to the Allan Memorial
Institute and to Dr. Cameron.
In early 1985, the Department of Health and Welfare re-
ceived an access to information request for "All letters
and reports between 1950-64 relating to Dr. Cameron's and
Allan Memorial Hospital's experiments in regards to pro-
ject MK Ultra, Human Ecology, Brainwashing, and any let-
ters and reports sent to the Central Intelligence Agency
(CIA), USA". In answering, the Department consulted its
master index, which lists nine psychiatric research pro-
jects for which Dr. Cameron is named as principal investi-
gator. Total funds for these nine projects amounted to
$495,444.41; the nine projects are listed in Appendix
27. In addition to these nine projects, I have identified
a tenth project, No. 604-5-433, which began in Dr.
Cameron's name and finished in 1965 in the name of a Dr.
Davis, Cameron having by then retired. This project is
entitled "The Influence of Psychotropic Drugs upon
Cerebral Responses to Peripheral Stimulation in Man".
I have reviewed files on eight of these ten projects. (No
files exist for the other two, Nos. 604-5-104 and
604-5-108, but from their titles as given in Appendix 27
it is apparent that they are not relevant here.) Of these
eight, it appears on examination that Dr. Cameron was the
principal investigator in only four; in fact, not only was
he not the principal investigator in the other projects
(contrary to the indication in the H&W master index), but
his name is not even mentioned in the project files still
available. It is speculated that, as head of the Allan,
he signed the original project applications although not
himself a participant.
Of the four projects in which Cameron was in fact prin-
cipal investigator, only two are relevant here (the other
two are No. 604-5-76, "A Study of the Effects of Nucleic
Acid Upon Memory Impairment in the Aged", and No.
604-5-433, referred to above). The two relevant files are:
(a) Project No. 604-5-14 (1950-1954; $17,875.00)
Under this project, entitled "Support for a
Behavioural Laboratory”, a number of experi-
ments were planned. One was to test memory
and learning impairment due to individual
and cumulative electric shock. Another was
to film patients against a checkered back-
drop before and after ECT treatment, to see
if any differences in physical movements
could be detected. A third was to study the
effects of sensory isolation. A fourth was
to investigate psychic driving techniques in
various situations: while the patient was
under hypnosis, in continuous sleep, and
when the patient's resistance was lowered
using the isolation techniques of Dr. Hebb.
The final report to H&W is reproduced at
(b) Project No. 604-5-432 (1961-1964; $51,860.00)
This project is entitled "Study of Factors
which Promote or Retard Personality Change
in Individuals Exposed to Prolonged Repeti-
tion of Verbal Signals"; i.e. psychic
driving. Copies of the summary and final
report are attached at Appendix 29. This
study gave rise to five published papers,
four of which are reproduced at Appendices e *
13, 14, 16 and 17.
It will be seen that both these projects had to do with Hl
psychic driving, used in combination with the procedures S€
of depatterning , sleep therapy and drugs. As will be seen *!<
in section 7, these were also the subjects of investiga- a
tion in the research work carried out by Cameron with CIA ol
A further word on one of the apparently unrelated
projects. No. 604-5-13, "Research Studies on EEG and
Electrophysiology", is in order. This was an extensive c *
project conducted at the Allan primarily by Dr. Lloyd
Hisey, Psychiatrist in Charge, Electroencephalographic and
Electrophysiological Centre (1950-1952) and his successor
as of July 1, 1952, Dr. Charles Shagass. Much of this a
work, of which there are extensive reports published in c<
the scientific literature, was supported by both H&W and
DRB . Although these studies deal with specific aspects of ei
psychiatric research, none of them bear directly on the r '
topics of depatterning and psychic driving. The work did, °
however, cover topics such as photic stimulation (the use _
of strobe lights)*, drug induced sleep and studies of the
effects of electroshock (see Appendix 30).
Interestingly enough, the Society for the Investigation of
Human Ecology (SIHE), the CIA "cover organization" (see
section 7 of this opinion) was also interested in Project
No. 604-5-74 , "A Study of Ultraconceptual Communication",
a 1959-61 study under the direction of Leonard Rubenstein
of the Allan (see Appendix 31). (Rubenstein was a colla-
borator with Cameron on the SIHE project on psychic
driving under the CIA's code name "MK Ultra Subproject
68", discussed in detail later). I have seen no suggestion
that the SIHE provided actual financing for this parti-
cular project, although it is conceivable that the CIA may
have been interested in the subject matter of the project,
dealing as it did with an examination of the ways in which
the voice can communicate information on both a verbal and
a non-verbal level, and can also convey feelings either
consciously or unconsciously which are either allied to
the verbal communication or reflect the speaker's
emotional disposition. In any event, this project is not
relevant to the subject matter under review in this
*Strobe lights, when flashed on and off at certain
frequencies, can bring on convulsion-like effects; thus it
was thought that the technique could assist in clearing
the "brain pathways".
In addition to these ten projects, there were of course
many other grants made to other researchers associated
with the AMI. Although I have not reviewed the files
relating to these grants - indeed, to do so would have
taken considerably more time and would have entailed a
considerable enlargement of my mandate - I have reviewed
H&W's list of projects funded between 1948 and 1963, and I
have no reason to think that any of them have a bearing on
the subject matter of this review.
(4) The method of dealing with Dr. Cameron's
Were Dr. Cameron's grant applications handled by the
Department of National Health and Welfare in the same way
as other applications?
A number of people I interviewed had been present at
meetings of the Research Sub-Committee of the Mental
Health Advisory Committee and recalled the fact that
Cameron had indeed made application to the Mental Health
Division for grants. However, none of them had any
recollection of the particulars of these applications or
of the ensuing grants. All those to whom I spoke advised
that Dr. Cameron's applications would have been treated in
the normal way; had this not been the case, they would
have remembered the fact.
At the same time, it was recognized by those I interviewed
that Cameron was looked upon as the doyen of Canadian psy-
chiatrists. In the view of many of them. Dr. Cameron's
pre-eminence in his field, added to his forceful and
aggressive personality, may well have resulted in a cer-
tain deference being shown to his applications by those
whose task it was to review them. There is no suggestion
that anyone shirked responsibility and let pass a research
project considered to be scientifically or medically
unacceptable, nor is there any suggestion that there was
not lively debate at the intellectual level when
applications were being reviewed; indeed this seems to
have been the norm even when applications of eminent
people such as Dr. Cameron were being considered. What is
suggested is that it is likely that some members of the
reviewing groups may have been somewhat reluctant to
express doubts, if indeed they had any, about the medical
or scientific basis for the procedures under review in the
proposal. It is to be emphasized that there is no actual
evidence that this occurred; but human nature being what
it is, it is in the view of some to whom I spoke
reasonable to assume that this kind of deference could
In summary, there is no evidence that the applications of
Dr. Cameron and the AMI were treated in any different
manner by the government and its outside consultants than
applications from any other quarter.
(5) Progress Monitoring
It was the Mental Health Division's practice to require
grantees to submit an annual progress report. In fact,
the grants themselves were made on an annual basis, while
more often than not the project was intended from the
beginning to last for a period of years. It was on the
basis of these annual progress reports that the grant for
subsequent years was approved by the Mental Health
In addition to this, it was the Department's practice to
send representatives on occasional visits to the
institutions where the work was being carried out; but
because health is primarily a matter falling under
provincial jurisdiction, departmental officials would ask
permission of their provincial counterparts to make the
visit. This permission was invariably granted, and
certainly in Quebec the work of checking up on ongoing
projects was carried out entirely by federal, not
provincial, officials. But the point is that the federal
government at all times "cleared the way" for the visits
of federal personnel to the grantees' institutions. The
visitors would also obtain the permission of the institute
itself in advance of the visit; there was no suggestion
of "surprise visits". Moreover, the visit was not in the
nature of an inspection; it did not constitute a detailed
financial, medical or scientific audit. It was simply a
matter of the Mental Health Division representative
hearing from the investigator about the work that was
being conducted under the grant, so as to be in a position
to evaluate the annual application for renewal and also to
ensure that the grant money was being spent generally on
the project for which the grant was intended.
So far as Dr. Cameron and the AMI are concerned, there is
no evidence that the annual visits were treated any
differently with respect to this institution than any
other. Indeed, it is my impression from interviews with
former civil servants that visits to the AMI may have been
slightly more frequent than to other institutions,
possibly because of its pre-eminence, and also because
Montreal was considered an agreeable place to visit I
This, however, is a matter of impression only; what is
clear is that there is no evidence to suggest that the AMI
was either ignored, or deliberately made the subject of
It may be asked how Canada's research grant system 4,
compared to that of other countries. Some scientists
certainly held the view that Canadian granting agencies
maintained much too close control of its grantees. Dr.
Heinz Lehmann, an eminent psychiatrist and head of the As
Verdun Protestant Hospital in Montreal (now known as the cc
Douglas Hospital Centre), certainly thought so, as is he
evident from the newspaper clipping at Appendix 32. Se
(6) Conclusions gr
In conclusion, it is my opinion that in relation to the co
structure and operation of its granting procedures, the em
Department of National Health and Welfare conducted itself wo
at all times in a prudent and professional manner. The moi
practice of careful internal review of all applications, qu«
followed by a referral of the applications to two experts
in the particular field from outside the Department for To
detailed and anonymous scrutiny and comment, followed in coi
turn by a review by the panel of qualified outside experts ext
forming the Mental Health Advisory Committee and its fit
Research Sub-Committee, in my opinion demonstrates the int
good faith and competence of the public servants lat
4. THE CLIMATE OF THE TIMES
A. The background to the National Health Grant System
As far back as 1919, Prime Minister Mackenzie King had
committed himself and his party to some form of national
health program for Canada. However, not until after the
Second World War did the idea of a national health program
at last appear feasible. The government recognized that
great improvements had to be made in the ability of the
nation to deliver health care across the country before it
could introduce such a program. There were simply not
enough facilities or personnel to meet the demands that
would arise upon the implementation of such a program, and
moreover there were vast regional differences in the
quality of health care.
To remedy these deficiencies, the federal government
conceived the idea of assisting the provinces in the
extension and improvement of services in specific health
fields, as a preliminary step towards the later
introduction of, first, the hospital insurance plans, and
later, national health insurance. In 1948, the government
set up the National Health Grants in ten separate fields
(later expanded to thirteen), including for example public
health, tuberculosis control, venereal disease, crippled
children and cancer. One of these was the Mental Health
The purpose of the Mental Health Grant was to cover
projects of three main types:
(a) to provide services in the community,
(b) to provide more adequate staff and equipment
in the mental hospitals and in the
psychiatric wards in general hospitals, and
(c) to provide training for personnel needed in
mental health work; this was considered to
include psychiatric research.
B . Some Background Data
When Prime Minister Mackenzie King announced the Mental
Health Grant in the House of Commons on May 14, 1948, he
" Mental Health Care - Parliament will be asked to
make provision for a similar grant to the provinces
for similar purposes for mental health care
amounting initially to $4 million per annum and
rising over a period of years to a maximum of $7
million per annum. The seriousness of the problem
of mental illness can best be illustrated by
reference to the fact that between one-third and
one-half of all hospital beds in Canada today are
occupied by patients suffering from mental illness . "
A few other figures from this era are of interests
"Mental and nervous diseases account for more
illness than cancer, infantile paralysis and
tuberculosis combined. At any one time, one out of
every 150 adults in the general population is
hospitalized because of mental disease is the
finding in areas where mental hospital facilities
are most nearly adequate (Landis and Page, Mental
"One person in 18 to 20 will spend some part of his
lifetime in a mental hospital."
"One person in 10 of the general population will be
incapacitated by some variety of mental disease at
some time during his life."
"There are 50,000 patients in the mental hospitals
of Canada. (DBS)"
The foregoing information comes from a memorandum dated
January 18, 1949 from departmental officials to the
Honourable Paul Martin, Minister of Health (copy attached
at Appendix 33). Grants for research came under the
heading of "personnel needed in mental health work". The
bottleneck in the expansion of mental health services at
that time was lack of trained personnel. The goal was to
increase considerably the number of psychiatrists,
psychologists, social workers, nurses and community
workers in the mental health area.
C. The state of psychiatry and the growth
in research after 1948
Psychiatry in the late 1940's and early 1950's was just
beginning to emerge from the era of the "lunatic asylum".
There was great hope, almost a yearning, on the part of
the medical profession, public servants and politicians
that some means might be found, through new techniques
such as electroshock therapy, insulin coma shock therapy,
psychopharmacology, etc., by which we would cure the ill,
and at the same time empty the hospitals of a substantial
- and costly - proportion of patients. Mental illness was
looked upon as one of the last great fields of human
suffering to be conquered. Scientists had discovered
spectacular new drugs such as sulfa and penicillin to cure
the physically ill; was there nothing that could be done
for the largest group of all, the mentally ill?
Such were the thoughts of many with whom I spoke during
the course of preparing this opinion. It is perhaps no
wonder, then, that in conquering mental illness, a field
in which so little had been done and so much was left to
do, a great sense of urgency permeated the thinking of the
times, and gave great impetus to find solutions, and as
quickly as possible. And the key to the solution was:
In a memorandum by Dr. Charles A. Roberts, M.D. , Chief of
the Mental Health Division, dated April 8, 1953 (copy
attached at Appendix 34), the following appears:
"When the National Health Grants Programme was
initiated, it was recognized that there was a great
need for research in the whole field of health ... At
the time there was a little research being conducted
by people in training and by the staff of Laval
University, by the staff of the Department of
Psychiatry at McGill University and at the Toronto
Psychiatric Hospital. Beyond this, I am unaware of
any mental health or psychiatric research being
conducted in the country at that time. " (Emphasis
And, in a report of Dr. Roberts to the Director of Health
Insurance Studies, dated August 20, 1953, on the subject
of the estimates for the 1954-55 Mental Health Grant,
reference is made to the fact that in 1947 little more
than $25,000 was spent on research in the field of mental
illness in Canada. In 1948, $4,850 was the figure. By
1953, this had increased to $461,626.
Dr. Cameron, the pre-eminent psychiatrist in Canada at the
time, was frustrated with the slow pace of progress in
developing new psychiatric procedures. He was always
looking for a breakthrough; in this he was in tune with
the sense of urgency that gripped this period in the
development of psychiatry. He was in the vanguard of the
thrust for research in an attempt to solve the outstanding
problems of mental illness. And as an ambitious
professional and an expert "grantsman", he was able to
keep himself in the forefront. The newspaper article
attached as Appendix 35 gives something of the intensity
with which Cameron viewed the cause of psychiatric
By the time of the eighth meeting of the Advisory
Committee on Mental Health, held February 28 and March 1 ,
1955, Mental Health Research Grants from the Department
had reached about $500,000, out of a total of approximate-
ly $1.6 million for research in the whole health field.
The mental health share was thus a substantial part of the
total, and the trend did not change. By the end of the
1962-63 fiscal year, a total of about $8 million had been
spent on mental health research since 1948, out of a total
of about $30 million for medical research in all fields.
The tremendous growth in psychiatric research demonstrated
by these figures is a clear indicator of how crucially
important the public service and the politicians of the
day regarded the problems of mental illness, and the sense
of urgency with which they and the medical profession were
determined to conquer the problem. This sense of urgency
was emphatically confirmed to me by the Honourable Paul
Martin, Minister of Health in the early years of the
National Health Grants program.
Finally, an impression of just how new the field of psy-
chiatry was as a discipline of its own may be gained from
the following starting dates for particular programs: Uni-
versity of Edinburgh, 1912; London, 1921; Toronto, 1936;
McGill, 1943; American Board of Psychiatric Examiners,
1935; Royal College of Physicians and Surgeons - Psychia-
tric qualification, 1944.
5. THE PERSONALITY, CHARACTER, AND PROFESSIONAL ACTIVITIES
OF DR. D. EWEN CAMERON, AND AN ASSESSMENT OF THE
QUALITY OF HIS WORK
A. Personality, character and professional activities
There is attached at Appendix 36 a series of extracts from
private papers of Dr. Robert A. Cleghorn, a psychiatrist
at the AMI from 1946 to 1970 (when he retired). In 1964,
Dr. Cleghorn succeeded Dr. Cameron as head of the AMI.
They were thus long-time associates. These extracts,
given to me on a strictly confidential basis by Dr.
Cleghorn, constitute the best source of direct information
I have seen, both as to the character of Dr. Cameron him-
self and as to the nature and quality of his professional
A number of other people I interviewed were acquainted
with Cameron; and what follows reflects the views not
only of Dr. Cleghorn, but of these other people as well.
"Acquainted" is the right word, because it seems no one
knew Dr. Cameron very well. He was an intensely shy and
private man, in spite of his great organizational abili-
ties and many public activities. For example, despite
their long association, Cameron never called Dr. Cleghorn
by his first name. The closest he ever got to intimacy
was "Doc" - and then only on rare occasions. And Dr.
Cleghorn was only once invited (socially) to Cameron's
apartment in Montreal. (A U.S. citizen, Cameron's
permanent residence was located at Lake Placid, New York
State, just across the Quebec border, and he apparently
spent his weekends there.) Nor, it seems, were there
others in the work place with whom Cameron allied himself
closely. As Dr. Cleghorn points out, there was no "No. 2"
at the AMI; and individual psychiatrists were free to
pursue their own interests as they wished and on their
Dr. Cameron was born in Scotland, the son of a Presby-
terian Minister. It seems that the father was an authori-
tarian figure, somewhat aloof from his son. A number of
people I spoke to alluded to this family background as an
explanation for a number of facets of Dr. Cameron's own
personality; his driving ambition, his resentment of au-
thority figures, his determination to prove himself and
his ideas without reference to or intellectual guidance
from the work of the great psychiatrists of the past -
Freud, Jung, Adler, Meyer, etc.
As a person, he was ruthless, determined, hard-driving,
aggressive and domineering, with a strong and forceful
personality. He was not a person that anyone would easily
or readily stand up to. He was a person much admired, but
seldom liked; in some senses, he was almost charismatic.
He was sometimes aloof from his patients and colleagues
alike. He seemed not to have the ability to deeply
empathize with their problems or their situations.
It is easy to see how such a person could be regarded as
the "mad scientist" of some media reports.
However this may be, it is clear that Cameron at the AMI
was an extremely ambitious, almost a driven, man. He was
motivated by ambition for personal fame as a psychiatrist
and as a builder of his profession. He wanted to create,
and succeeded in creating, a leading centre for psychia-
tric training and research. In personal terms, it would
seem that he wanted nothing more than to break through the
barriers to understanding mental illness that then existed
and to make his mark as a world leader in research.
He received extremely good training as a psychiatrist;
see Appendix 5, p. 3 and Appendix 36, Part I, pp.
109-110. In terms of his professional associations, he
could not have done more. He was the President of the
Canadian Psychiatric Association, the American Psychiatric
Association (1953), and in 1963 became the founding
President of the World Psychiatric Association, an
organization largely formed through his own efforts.
He was the author of 104 papers and four books. His
reputation in his profession may be gleaned from the
retirement and obituary notices in professional journals
(Appendix 36A). He died in 1967.
He was motivated to help mankind in his chosen field of
psychiatry. While not a warm man in the sense of having
close personal associations, those who knew him conclude
that there is no question as to his fundamental dedication
to the improvement of mankind through medicine.
He was a brilliant administrator and organizer. He took
the AMI from a standing start in 1943 to the pinnacle of
the huge success and reputation that it enjoyed in the
late 1950's and early 1960's. He was a good teacher,
dedicated to improving both the quality and number of
mental health workers in Canada. When he took over at the
AMI in 1943, the country was pitifully short of trained
psychiatrists. By the time he retired in 1964, he had
built up at McGill Canada's leading centre for the
training of psychiatrists - in fact it was one of the
largest in the world. Under him, more than 1,000 psychi-
atrists were trained, and many of these went on to attain
great eminence in the psychiatric profession across the
country and around the world, in academic and admini-
strative positions and in public and private practice.
Throughout his time there, the AMI was a beacon that
attracted to McGill from all over the world gifted
students and outstanding professors representing a wide
range of psychiatric opinion and practice.
Dr. Cameron was a strong and early advocate of the "open
door policy" in the treatment of the mentally ill, a
policy that attempted to take psychiatry in the public
mind out of the era of the asylum, in which "untreatable
lunatics" were locked away more or less forever, into an
era of treatment in which mental illness was to be looked
upon as just another medical affliction. He regularly
held "open houses" at the Allan, to which members of the
general public were invited to see the work being done
In general, there are two schools within the profession of
psychiatry — the psychoanalytic school (Freud), and the
"physical" school that believed mental illness could be
explained and cured in physical terms. Cameron was firmly
in the latter camp. He did not have a great deal of faith
in psychoanalysis. Psychoanalytic procedures were very
time-consuming; this was very costly and, more important,
meant that the patient suffered longer while waiting to be
cured. Cameron's procedures, based on the "physical"
approach, were designed to ease the suffering of patients
in a shorter time. Cameron's methods did not work.
Psychiatry is still searching for methods that will.
However, the fact that in the years since 1964 the
physical approach has fallen somewhat out of fashion in
favour of the analytical approach, makes it more difficult
for psychiatrists and others to look at the problem
through 1950's and 1960's eyes (as we must in passing
judgment both legal and ethical) rather than through the
eyes of the 1980's.
Finally, some background on the relationship among McGill
University, the Royal Victoria Hospital ( RVH ) and the
Allan Memorial Institute (AMI) would be helpful. McGill
and the RVH are separate legal entities. However, the RVH
is associated with McGill in that it is a teaching
hospital of the McGill University's Medical Faculty (one
of five such hospitals), and people on the hospital's
staff hold cross appointments at McGill. The AMI is the
psychiatric wing of the RVH and here again, the staff hold
Thus, Dr. Cameron held an appointment as Professor and
Chairman of the Department of Psychiatry in the Faculty of
Medicine at McGill University. He was also Chief of
Psychiatry at the RVH, and at the same time Director of
the AMI. He received a salary from McGill; in addition he
obtained income from private patients. However, since the
AMI was the psychiatric wing of the RVH, in medical
matters he was responsible to the RVH.
B. An assessment of Cameron's abilities as a
(1) General conclusion
Dr. Cameron was not a good scientist. By this I mean,
skilled as he might have been in medicine in general and
in psychiatry in particular, he was not a sound practi-
tioner of the art or skill of scientific research. Like
many medical doctors of the day, especially psychiatrists,
he did not have a good understanding of basic scientific
methods. He would not plan his research in a proper
scientific way, with clear goals in mind, with proper con-
trols against which the results of his work could be mea-
sured, and with sufficient follow-up after the procedures
had been completed to see whether the results held up over
time. Like many medical doctors, his analysis of the
efficacy of a particular treatment would sometimes not go
much further than the observation that "the patient seems
better today". Dr. J.W. Fisher, a research scientist with
a Ph.D. in virology, in about 1952 wrote a draft critique
(undated) on this subject while he was employed as an
officer in the Mental Health Division. In it, he examined
all of the Mental Health Research Grant applications and
progress reports, listing their defects from the point of
view of scientific methodology. The critique is attached
at Appendix 37; for present purposes, perhaps his most
important point, found at the end of his summary, is this:
"In making these statements I wish to make it
clear that in no instance is the integrity of
the grantee and his associates questioned, nor
is it implied that good research work was not
done in experiments well designed to provide
data, which on an appropriate analysis, would
provide unambiguous answers to the questions the
experimenters wished to answer. Rather, these
conclusions arrived at only indicate that the
majority of the grantees failed, for some reason
or another, to provide evidence supporting the
excellence of their work. Regarding all this I
think of the words of Louis Pasteur, 'In
experimental science it is always a mistake not
to doubt when facts do not compel you to
affirm. ' "
(2) The Hawthorne and placebo effects
A major shortcoming in Dr. Cameron's methodology was his
failure to allow for the so-called "Hawthorne effect",
and/or the "placebo effect".
A hospital staff trying out a new procedure will often ex-
pend much more time and effort with the patient than in
the case of routine treatments. Often there is an air of
expectancy, even excitement. Patients do indeed appear to
get better, but this is often due to the extra attention
being paid to them, rather than to the treatment.
Similarly, if told a new drug will help, one finds that
the patient does in fact improve - even if the "drug" ad-
ministered is a neutral substance (placebo). Similar
effects are noted in other fields. A new method of per-
sonnel management is introduced at the office; productivi-
ty picks up; after a while, the "new" procedure becomes
routine and productivity goes back to normal. These
"Hawthorne" and "placebo" effects are well known today,
and they operate with particular force in the case of men-
tally ill patients, due to the nature of the illness.
Modern scientific research is carried out in such a way as
to eliminate them, through "double blind" techniques
(where neither the patient nor the person administering
the "drug" knows whether it is a placebo or not) and other
Cameron failed to allow for these effects in his research
and treatment, and he failed to discount them in assessing
results. Depatterning and psychic driving involved tre-
mendous efforts on the part of many professionals, bring-
ing patients into intimate contact with staff over many
months, even years, as is shown by the underlined portion
of the quotation from one of Cameron's articles, set out
in section 2.E. of this opinion.
Cameron's patients did indeed "seem to be getting better",
but this may well have been due to the operation of these
effects, not Cameron's treatments.
The fact that the Hawthorne effect was likely at work in
Cameron's research became apparent with the results of the
study on depatterning ordered by Dr. Cleghorn when he
replaced Cameron as head of the Allan in 1964 (See
Appendix 38). In brief, the study shows that, in general,
patients who had received depatterning were no better off
than those who had not, after a few months or years (i.e.
after the Hawthorne effect had worn off). It was on the
basis of this study that Dr. Cleghorn stopped the
depatterning procedure at the Allan.
Should Dr. Cameron have taken the Hawthorne and placebo
effects into account in performing his research and
treatments? A really first class scientist probably would
have. That is why I have said in section 2.H. of this
opinion that depatterning "was not justifiable even by the
standards of the time and even in the light of the rather
rudimentary level of scientific and medical knowledge of
those days compared to today."
On the other hand, as Dr. Cleghorn says (Appendix 36, Part
II, pp. 37-38) these effects had not reached common notice
until the 1950's, and:
"It was the 20 to 25 year period from 1935 [i.e.
1955 to 1960] before the concept of adequate
controls [such as making allowance for the Hawthorne
and placebo effects] had assumed a regular place in
medical research, and longer for psychiatry, for it
had less involvement than medicine in the basic
sciences, therefore was even more laggardly. 11 '
If Cameron was at fault for not taking these effects into
account during research and treatment, and for not doing
long-term follow-up studies on his patients to determine
whether it was the treatment or something else that seemed
to make them better, then he was in the company of many
others. For example, as Dr. Cleghorn points out (Appendix
36, Part II, p. 37), it was not until twenty years after
insulin shock therapy treatment came into effect in the
1930's that psychiatrists realized the treatment had no
value for a large range of patients; patients just felt
better because of the attention paid to them. Neverthe-
less the treatment, equally as intrusive as massive elec-
troshock and if anything more dangerous, was still in use
in Canada until well into the 1960's. Medicine and psy-
chiatry provide many other examples of this failure to
take these effects into account in the 1950 's and early
1960 's when the necessity for proper scientific controls
was not as widely understood by the medical profession,
particularly psychiatry, as it is today.
It is for this reason that in section 2.H. of this opinion
I qualified the conclusion there stated (and restated
three paragraphs above) with the statement that this con-
clusion is only apparent with the benefit of hindsight.
(3) The background for the general conclusion on
Dr. Cameron's abilities as a research scientist
The state of affairs discussed in the last subsection has
changed in the 1970's and 1980 's, but Dr. Cameron's
deficiencies in this regard were typical of the medical
profession, especially psychiatry, in those days. (See
the reports of Dr. MacDonald, Appendix 5, pp. 2-3 and 6;
and Dr. Lowy, Appendix 6, p. 6.)
Cameron was therefore not at all unique in being deficient
in scientific method and the techniques of scientific
research. Research in medical fields did not really get
underway until the 1930 's and it was twenty or thirty
years before they came to be fully accepted (see the views
of Dr. Cleghorn in Appendix 36, Part I, p. Ill and Part II,
p.27 and p.37). In fact an examination of research by
other psychiatrists active at the time shows that the
scientific quality of Cameron's work, though poor, was "no
less rigorous" than, or at least "not significantly worse
than", those of his contemporaries in psychiatric
research: See Dr. Lowy, Appendix 6, p.6, and Dr.
MacDonald, Appendix 5, p.6. As further evidence of this
there is the fact that his work was widely published in
peer-reviewed scientific and medical journals. Moreover
in Dr. Fisher's detailed assessment of the scientific
quality of research programs that had been carried out to
that date in mental health (Appendix 37), Dr. Cameron's
projects, though not free of deficiencies, come off well
If, therefore, Cameron's research work in the field of
massive electroshock therapy and psychic driving left a
great deal to be desired from the scientific point of
view, as it undoubtedly did, this failing does not in
itself show that the work in question was deliberately
aimed at some purpose other than the benefit of the
patient. As explained, the view of the doctors I inter-
viewed and of the three experts I engaged is that the
benefit of the patient was indeed Cameron's true aim, a
fact which they believe is demonstrated by Cameron's
professional writing (Appendices 7 to 17).
(4) Reservations of psychologists
It is right to note here that some of the psychologists
whom I interviewed hold a more sceptical view of Cameron
than do the medical doctors. Also, as noted earlier. Dr.
Donald 0. Hebb was also sceptical of Dr. Cameron's methods
and scientific abilities. Being schooled in a related
field, and having the added advantage of training and
experience in scientific method and in research, this
attitude is perhaps natural.
What is noteworthy, however, is that, like the medical
doctors, none of the psychologists spoke up in opposition
to Dr. Cameron at the time when the work was being done.
My conclusion is that it is only with the special know-
ledge that comes with an understanding of scientific me-
thods and proper procedures for scientific research, and
in some cases with the benefit of hindsight and perhaps in
the light of the allegations made by the nine plaintiffs
in the U.S.A., that these psychologists now find them-
selves more strongly critical of Cameron than the medical
C. Conclusions on the quality of Dr. Cameron's work and
its place in the context of the times
After interviewing thirty-one people now or formerly ac-
tive in the field of mental health research, and with the
benefit of the opinions of three independent experts, the
conclusion on all of this material that comes closest to
the real truth, in my opinion, is that Cameron was a good
man in the sense that he was trying to do the best he
could for his patients, a good doctor in the sense that he
understood his medical speciality well enough to practice
it, but that the poor quality of his scientific research
led him into serious error. What is clear is that, while
there were private doubts about the efficacy of psychic
driving and depatterning , the details of which are dis-
cussed fully at the end of this section, no one raised
these doubts at the time in such a way as to suggest that
these treatments were improper. In particular, no one -
whether a psychiatrist, psychologist or in another field
- associated with the Mental Health Division of the
Department of National Health and Welfare, or with any of
its external research advisory committees, had doubts
strong enough to suggest that grants ought not to be made
to Dr. Cameron because of the nature or quality of the
work he was carrying out.
It is also relevant to note that this is not a case of
"experiments" carried out on socially disadvantaged
patients who were under compulsion or did not know any
better. Cameron's was a "carriage trade" practice; his
patients were for the most part voluntary, having been
referred to him by other doctors in private practice, both
general practitioners and other psychiatrists, in the
belief that he was a leading psychiatrist of the day.
It was Cameron's practice to send regular written reports
to the referring doctors, explaining his procedures in
These facts constitute strong evidence of the high regard
in which he was held, and of the views of the medical
community generally as to the efficacy and propriety of
In this connection, two points might be noted. First of
all, while no depatterning and psychic driving treatments
of this nature are carried out today and indeed almost
certainly could not be, given today's much stricter
standards of research and treatment, nevertheless some
psychiatrists believe that some patients were indeed
helped by these procedures. Included among these are Dr.
Cleghorn himself, who knows of at least some patients who
in his opinion did in fact benefit, and knows personally
of no patient of whom it could be said with certainty that
they were worse off because of the depatterning procedures
than they otherwise would have been. Dr. Charles A.
Roberts also feels the same way. Almost all doctors -
including certainly Drs. Cleghorn and Roberts - would
however agree that these procedures were false trails in
the field of psychiatric research and treatment, and that
on balance the treatments were of no benefit. Certainly
there is no suggestion on anyone's part that the
techniques should be revived today, given all the new
techniques and procedures (especially psychopharmacology)
now available to the profession.
It should be further noted that much more intrusive and
intensive psychiatric procedures were readily accepted in
the 1940's, 1950's and early 1960's than would be accepted
today. For example, electro convulsive therapy was
applied in the early days without the benefit of muscle
relaxants, such as chlorpromoz ine , curare, etc. These
treatments often resulted in the patient undergoing ex-
tremely violent muscular spasms; some patients even broke
their backs. In those days too, the surgical procedures
of lobotomy and leucotomy were developed and in widespread
use. These involved nothing less than the surgical de-
struction of certain parts of the brain, which did indeed
succeed in relieving the patient's adverse mental condi-
tion, but at the same time destroyed the person's feelings
and whole personality. The technique of insulin coma shock
therapy was also highly intrusive and at least as danger-
ous as massive electroshock treatments. And some of the
newer experimental drugs, such as LSD-25, were also highly
intrusive because of their incredible power to alter the
state of the mind. In the authoritative textbook,
Kalinowsky and Hoch, 2d ed. (1957), massive electroshock
therapy is treated without adverse comment (See Appendix
38A). None of these procedures are used now, nor would
psychiatrists today recommend that they be reintroduced.
The fact is that massive electroshock therapy and psychic
driving did not appear as out of place in the 1950's and
early 1960's as it does today. While certainly not regard-
ed as benign, these procedures were nevertheless not re-
garded as lying outside the realm of the acceptable, in-
volving as they did intrusions of the same order of magni-
tude as those associated with other psychiatric techniques
of the day. And indeed, given the state of psychiatric
knowledge at the time, and given the overwhelming problems
with which psychiatrists were faced - hundreds of
thousands of severely ill mental patients and few tools
with which to relieve their agony and distress - many
people I interviewed felt the medical profession was right
to try new techniques. It is no argument against Dr.
Cameron's procedures, any more than it is against many
other equally intrusive techniques, to say that today -
with our much more sophisticated understanding of the
workings of the mind and our much broader range of treat-
ments - they appear to be barbaric.
D. Knowledge held by H&W employees as to the
quality of Dr. Cameron's research
None of the public servants to whom I spoke recall ever
having heard any adverse views expressed, either from
within Departments of government or by external reviewers
or by outside research advisory panels, as to the proce-
dures or techniques being utilized by Dr. Cameron and the
AMI. If at the time of a grant application they had heard
"mutterings" , the practice would have been to discuss them
and make an evaluation as to whether the research project
in question had sufficient scientific and medical merit to
warrant its being funded by agencies of government.
It is true that in those days public servants and members
of the advisory panels did not consider it to be their
responsibility to be much concerned about the ethics of
the proposed research, or about the quality of the consent
that had been obtained from the patients and/or volun-
teers. Compared to the attitude of today, responsibility
rested much more on the doctor or scientist carrying out
the research, and much less on either the institute to
which he was attached or on the granting agency; it was
simply assumed that ethical people did ethical things.
(This point is discussed in greater detail in Section 6).
Nevertheless, the persons to whom I spoke all suggested
that, had there been concern that the research project was
improper or unethical, and not for the therapeutic benefit
of the patient, the matter would certainly have been
raised either internally, by the external reviewers, or by
the outside research advisory panels.
E . Conclusion on the efficacy and propriety
of: Dr. Cameron *s research, and contemporary
The evidence contained in the file materials, the evidence
of the people I have interviewed and particularly the
opinions of the three experts, all point to the conclusion
that the work done by Dr. Cameron and his associates,
though today regarded by most medical and scientific
people as unsound, was not carried out for any improper
purpose, but was intended by Dr. Cameron and his
associates to be of therapeutic benefit to his patients.
This does not, of course, dispose of the ethical question,
which is discussed in the next section of this report.
Nor is this conclusion free from controversy.
There were a number of psychiatrists and other medical
doctors with whom I spoke who either had doubts themselves
at the time as to the propriety (and indeed the efficacy)
of Dr. Cameron's work, or who heard expressions of doubt
on the part of others. There were others who at the time
had no such doubts, and also some who had formed no
opinion. The three experts I engaged have each concluded
that Cameron's procedures were acceptable given the
knowledge and climate of the times, and none of the other
psychiatrists or medical doctors I spoke to expressed a
contrary view. I concur with this conclusion. I have
thought it desirable, for the sake of completeness, to
list all comments I have heard (even casual comments from
those who support this conclusion) that might be taken to
be adverse to it. These comments are as follows:
(1) Dr, Omond Solandt - Dr. Solandt, as chairman of
the Defence Research Board, had a close
colleague whose wife became a patient of Cameron
and underwent the depatterning procedure. After
a year, Cameron simply sent her back home and
advised in a rather peremptory way that he could
do no more for her. Dr. Solandt and his
colleague inferred from Cameron's report that he
had depatterned the patient and was not able to
repattern her. Dr. Solandt became sceptical of
the efficacy of Dr. Cameron's methods and indeed
formed the opinion that he was not possessed of
the necessary sense of humanity to be regarded
as a good doctor. He let it be known quietly,
through Dr. W.N. Morton (now deceased), the
Director of the Biological Research Division at
the DRB , that he (Solandt) would not look
favourably on any application that might be made
by Dr. Cameron to the DRB for research in the
psychiatric field. (The AMI did apply for, and
received, grants from the DRB and these are
discussed in section 3 of this opinion; but
these grants were not for work in the field of
It is speculated that Dr. Morton may have passed
the message on to Cameron, probably in an inno-
cuous way by suggesting to him that there would
not be much point in making grant applications
to the DRB because the DRB was not interested in
carrying on work within Dr. Cameron's field.
Dr. Solandt did not take this matter any
further, for example, by taking official action,
because he was not a psychiatrist, and because
his one exposure to Cameron's procedures was of
a private and personal, not of an objective and
Although Dr. Solandt is not a psychiatrist, he
is clearly one of Canada's most gifted
scientific and medical research administrators.
For this reason, I consider his contemporaneous
reservation about the efficacy and propriety of
Dr. Cameron's treatments to warrant very close
consideration. Nevertheless, I do not consider
Dr. Solandt's reservation to be of sufficient
force to change my conclusions as to the legal
or ethical responsibility of the Government of
Canada. While it turns out that his instincts
about the efficacy of Dr. Cameron's techniques
were quite right, his was not a scientific but
an intuitive and personal judgment based on one
failure (as he saw it) of the depatterning
technique. Cameron himself appears to acknow-
ledge that in some cases the depatterning
procedure was not successful; see (for example)
pages 69-70 of the article attached as Appendix
15 and Dr. Cleghorn's papers, Appendix 36, Part
II, p.31. In my opinion, the casual and non-
scientific observation of the failure of one -
or many - patients to be improved as the result
of a medical procedure is not sufficient ground
on which to base a conclusion, however correct
it may prove in retrospect and however eminent
the observer, that Cameron’s procedures were
improper when judged by the standards of the
day. Dr. Solandt agrees with this view.
(2) Dr. Robert A. Cleghorn - It is noteworthy that
Dr. Cleghorn was doubtful, as many others were
at the time, of the efficacy of the procedures.
Cameron himself set up a committee in the early
1960's under Dr. Cleghorn to see what might be
done to curb the excesses of one particular
member of the AMI staff, whose practice was to
use massive electroshock therapy in an almost
indiscriminate way. The offender's appointment
at the Allan was eventually terminated. And in
1964, as noted previously. Dr. Cleghorn himself,
upon succeeding Cameron as Director of the AMI,
set up his own committee to examine the depat-
terning treatment. The committee concluded on
analysis of the procedures that had been
followed and on examination of a large number of
patients who had received the treatment, that it
had not been efficacious. To quote them
"Results of our follow-up investigation
indicate that, in terms of both recovery
rate and current clinical condition,
patients who received intensive electro
convulsive shock therapy cannot be dis-
tinguished from those who receive other
forms of treatment. . .The incidence of
physical complications and the anxiety
generated in the patient because of real or
imagined memory difficulty argue against the
administration of intensive electro consul-
sive shock as a standard therapeutic
As a result of this study. Dr. Cleghorn put a
stop to the use of the procedure at the Allan
Dr. Cleghorn in his private papers describes the
treatment as "therapy gone wild with scant
criteria"; (Appendix 36, Part II p.88); but in
my discussions with him he gave me to understand
that in this passage he was addressing the
general effect of the treatments on patients as
judged with the benefit of hindsight, not
Cameron's purpose or attitude or mind in
carrying them out. As is obvious from his
private papers. Dr. Cleghorn writes with con-
siderable style and flair. On reflection, he
feels the colourful phrase quoted above is an
overstatement and, as his private papers read as
a whole (as well as his discussions with me)
make clear, at no time, then or now, did he hold
the view that Cameron's work was either scienti-
fically or ethically improper, given the
standards of the day. In fact, he concludes
that Cameron's intentions were to benefit his
patients, and indeed believes that some of them
may in fact have benefitted from the treatments.
Finally, in 1966 at an international psychiatric
conference. Dr. Cleghorn bumped into Dr.
Cameron, who asked about the status of the
depatterning procedures. When Cleghorn told him
that he had stopped them, Cameron replied, "I
thought you would."
In conclusion, it is clear to me from dis-
cussions with Dr. Cleghorn and from his private
papers that in his view Cameron's work was
representative of a legitimate area of inquiry
given what was known at the time, but that when
more information became available as a result of
the follow-up study set up by Dr. Cleghorn when
he became head of the Allan (Appendix 38), it
became apparent that Cameron's procedures were
not efficacious, and Cleghorn therefore stopped
(3) Dr. F.C. Rhodes Chalke - Dr. Chalke, a psychi-
atrist, former employee of the Defence Research
Board, lecturer at the AMI and later President
of the Canadian Psychiatric Association, had
some doubts at the time. He was asked, by the
family, to take as a patient the widow of a
former medical colleague, after she had been
unsuccessfully given the depatterning treatment
by Dr. Cameron. It was Dr. Chalke' s job to
attempt to treat her for severe depression. It
was this particular experience that gave rise to
doubts on his part. Nevertheless Chalke, too,
did not raise these doubts publicly; parti-
cularly in light of doctor/patient confident-
(4) Dr. Charles A. Roberts - Dr. Roberts was from
1951 until 1957 the head of the Mental Health
Division of the Department of Health and
Welfare. He had some private doubts at the
time, but like others refrained from expressing
them in view of Dr. Cameron's pre-eminence in
the psychiatric profession in Canada.
(5) Mr. John Osborne - Mr. Osborne, a former H&W
economist with no medical or scientific
training, remembers attending a meeting, perhaps
of the Dominion Council of Health, sometime in
the 1950's. While walking down the aisle of the
meeting room, he overheard Dr. G.D.W. Cameron
(now deceased) , the then Deputy Minister of
National Health and Welfare, saying to either
Dr. Charles Roberts or Dr. Ken Charron (Mr.
Osborne cannot remember which) that he thought
that Dr. Ewen Cameron of the AMI was going too
far. This was just a snatch of conversation
and was never pursued by Mr. Osborne. Neither
Dr. Roberts nor Dr. Charron remember the
(6 ) Dr. Craig Mooney and Dr. J.W. Fisher
These persons expressed keen reservations to me
about the adequacy of Cameron's work. Dr.
Mooney is a psychologist, and Dr. Fisher a
virologist. Dr. Mooney was at different times
secretary of the Subcommittee on Research of the
Mental Health Advisory Committee of the Mental
Health Division, H&W, and was head of the
personnel research section of the Human
Resources Section of the Defence Research
Dr. Fisher, as a research officer with the
Mental Health Division from about 1950 to
1956/57, personally reviewed all applications
for Mental Health Grants received by the
Division in that period. Their reservations had
to do with the lack of scientific rigor with
which the research work was carried out. A more
detailed discussion of Dr. Fisher's views
appears elsewhere in this opinion. To repeat,
the basic point is that in the 1950's and early
1960's medical researchers generally and psychi-
atrists in particular did not have a good grasp
of scientific research methods, in contrast to
psychologists and others with scientific
In my interview with Dr. Fisher, he considered
the period in question (the 1950's) to be the
"age of clinical experimentation" where new
therapies were being tried quite freely and
frequently. He gave the example of
tranquilizers. Certainly his written assess-
ments at the time do not suggest Cameron's work
was any more inadequate scientifically than that
of other researchers.
(7) Sir Aubrey Lewis - Lewis and Cameron both took
their residencies in psychiatry at Johns Hopkins
University in 1926 under Dr. Adolf Meyer. Their
relationship, personally somewhat strained, is
described in Dr. Cleghorn's notes in Appendix
36, Part II, pages 85-87. In 1957, when Lewis
was head of the famous Maudsley Hospital in
London, he told Dr. Cleghorn privately that he
thought Cameron's depatterning treatments were
"barbaric"; but on the other hand Cameron was
invited to the Maudsley as a special guest
lecturer in 1962 while Lewis was still in
charge, an invitation that would be out of the
question if there were any contemporary doubt in
the mind of Lewis or that of the profession
generally as to Cameron's scientific and medical
competence or ethical standards.
The foregoing comments, together with those referred to in
the expert reports of Drs. Grunberg, McDonald and Lowy,
(Appendices 4,5 and 6 respectively) constitute all of the
comments I have heard or read which might be taken to
point to a conclusion opposite to that which I have
reached (namely that Cameron's research work was not
improper given the practices, the standards, the level of
knowledge and the climate of the time in which it was
- 86 -
carried out) . It is noteworthy that the general thrust of
these doubts had to do more with the efficacy of Cameron's
treatments than with their ethical quality.
It will be appreciated that the conclusion I have reached
cannot be stated in absolute terms. While all the medical
people I spoke to, including the three experts, agree with
it, some psychiatrists would probably disagree. My con-
clusion to this question, the penultimate one I have had
to address, is therefore not free from controversy. The
answer to the ultimate question - whether the Crown is
responsible legally or morally - is in my opinion much
less free of controversy. This question is taken up in
sections 9 and 10 of this opinion.
6. ETHICAL CONSIDERATIONS SURROUNDING THE NATURE AND
QUALITY OF DR. CAMERON'S ACTIVITIES, AND THE ISSUE
OF PATIENT CONSENT
In developing this section of my opinion I have relied
heavily on the opinions of Drs. Grunberg, McDonald and
Lowy, attached as Appendices 4, 5 and 6 respectively.
A. Ethical standards in medical research and
We start with this, that some form of "experimentation" is
essential if any progress is to be made in medicine. To
quote from THE DECLARATION OF HELSINKI AS REVISED (1975),
"Recommendations Guiding Medical Doctors in Biomedical
Research Involving Human Subjects":
"Medical progress is based on research which
ultimately must rest in part on experimentation
involving human subjects."
"In the field of biomedical research a fundamental
distinction must be recognized between medical
research in which the aim is essentially diagnostic
or therapeutic for a patient, and medical research,
the essential object of which is purely scientific
and without direct diagnostic or therapeutic value
to the person subjected to the research."
The Helsinki Declaration was adopted by the World Medical
Association in 1964 and revised in 1975; the Working Group
on Human Experimentation from the Medical Research Council
of Canada has described it as the most important of many
attempts to provide standards in biomedical research, and
cvpvresents as no other document the consensus of the world
tomunity: see page 9 of Report No. 6, "Ethics in Human
Experimentation", published 1978, attached as Appendix 39;
the Helsinki Declaration is Appendix C-2 to this Report.
The question is, of course, what are the legal and ethical
limitations on such work?
Society's ideas on this important subject have changed
considerably in recent years. They have changed in general
terms and they have also changed in specific terms. As
for the latter, the specific requirements imposed on medi-
cal researchers today to ensure that their work meets
ethical standards are spelled out in much more detail now
than they were in the 1950's and early 1960's. Certainly
scientists and medical doctors have never been ethically
or legally permitted to conduct pure experiments on
humans, in the sense of carrying out procedures on un-
willing and unwitting victims for a purpose not intended
to be beneficial to the patient, but rather for some other
purpose such as the advancement of science, or to increase
medical knowledge generally. However, until recent times,
and certainly in the 1950's and early 1960's, much greater
reliance was placed on the integrity of the person con-
ducting the research than today. The major burden of de-
ciding the ethical questions was placed squarely in the
hands of the individual responsible investigator. To
quote Drs. Lowy (Appendix 6, p.10) and Grunberg (Appendix
4, pp.9-10) there was an attitude of "benign paternalism"
towards the investigator.
To be sure, the institution (in this case, the AMI) and
the granting agency (in this case the Department of
National Health & Welfare) always bore some measure of re-
sponsibility, as both Dr. Lowy and the MRC Report make
clear. But this responsibility was vaguely defined at
best until at least the late 1960's and 1970's.
In 1978, after considerable debate within the profession,
the Medical Research Council of Canada produced the
guidelines set out in Appendix 39. Thereafter, those
engaged in medical research of an experimental kind who
applied for grants from the MRC were obliged to follow
these guidelines. They are now standard in Canada, even
for research in which the MRC is not the granting agency.
The research that Dr. Cameron carried out in the 1950's
and the 1960's could almost certainly not be carried out
today. His research project would first have to be re-
viewed by the scientific review committee of the AMI (or
the Royal Victoria Hospital), and it is highly unlikely
that they would approve his research on scientific grounds
due to its weak theoretical basis and inadequate methodo-
logy. Then, the project would have to go before the
ethics committee, a committee usually consisting of medi-
cal doctors, research scientists and lay people. Commit-
tees of these kinds did not exist when Dr. Cameron was
active. Their existence today, though not providing
absolute guarantees, makes it much less likely that a re-
searcher could carry out scientifically weak or ethically
questionable research. This is especially so since nowa-
days not only does the MRC require the researcher to
attach to the grant application an ethics certificate from
the institution's ethics committee, but also officials
within the civil service who review the application, the
external reviewers and the research advisory panels are to
raise any concerns of an ethical nature that they might
have in regard to the proposed research. While this was
also true in the 1950's and early 1960's, the custom then
was to place much greater reliance on the integrity and
competence of the investigator. Only in a clear case
would the external reviewers be expected to raise ethical
concerns. And, as detailed in section 5, I have uncovered
no evidence to suggest that such concerns existed or were
brought to the attention of the granting agency in
relation to Dr. Cameron's research.
The difference in approach between Cameron's time and our
own may be discerned by examining the current MRC grant
application form and ethics certificate at Appendix 40 and
comparing it to the actual application signed by Dr.
Cameron in the Mental Health Grant Project No. 604-5-433
at Appendix 41. Neither the latter application nor the
then current departmental memoranda on research grants,
found at Appendix 26, refer to the question of ethics.
B. The question of consent
I turn now to the question of consent. The practice in
the 1950's and early 1960's was to obtain a form of
general consent. From the Orlikow and Morrow cases, we
have examples of the kinds of consent actually obtained by
the AMI. These consents, together with those for two
other plaintiffs in the U.S. law suit (Mrs. Zimmerman and
Mr. Weinstein), are attached at Appendix 42. See also
Appendix 1A, p.14.
The fact is, general consents of this kind were regarded
by all in those days as ethically adequate, and in
addition they were sufficient in law to shield the doctor
and the institution from legal liability.
Today the situation has been substantially altered. This
is due to the adoption since those days of the doctrine of
"informed consent", under which in experimental proceed-
ings or novel therapies the patient must be given a full
explanation of what is going to happen, the likely side
effects, alternative treatments available if any, the
consequences of not taking the treatment etc. (Here it
should be noted that while Dr. Cameron's procedures were
initially experimental or at least in the nature of thera-
peutic research, he later looked upon them as routine. It
should also be noted that neither in the- 1950's and early
1960 's, nor today, do granting agencies concern themselves
with the question of consents from individual patients.
It is simply assumed that such consents will be obtained.)
C. Some developments subsequent to Dr. Cameron's tenure
at the Allan in the matters of consent and choice of
The following developments will highlight the changes that
have occurred since Dr. Cameron's time:
(1) The Halushka Case : This case, cited as Halushka
v. University of Saskatchewan et al. (1965), 53
D.L.R. (2d) 436, (Sask. C.A.) established
clearly the doctrine of informed consent in
medical experiments. The doctrine has since
been elaborated and extended.
(2) The "Patient's Rights" movement : This movement
began in the mid 1960's in the U.S., as is
evident from the September 1985 article attached
as Appendix 43, taken from "Canada's Mental
Health", a journal published by Health and
Welfare Canada. The article gives the history
of the Patient's Rights and Ethics Committee at
the Douglas Hospital Centre in Montreal
(formerly the Verdun Protestant Hospital). The
Committee began in 1966 in response to a new
development from the U.S.: the requirement of
the U.S. Department of Health, Education and
Welfare that any institution seeking research
grants from the U.S. government needed to have
an ethics committee review the research protocol
before they could qualify. See also Schwartz,
"Institutional Review of Medical Research"
(1983), J. Legal Med. 143.
(3) The Helsinki Declaration , found at page 61 of
Appendix 39, came out first in 1964. The Nurem-
burg Code of Ethics in Medical Research (on
which Dr. Cameron worked), a result of the post-
war Nuremburg Trials, was found inadequate to
meet the changing views of society on control
over biomedical research. Hence the 1964
(4) Dr. Edmund Pellegrino , Professor of Medicine and
Medical Humanities at Georgetown University,
Washington, D.C., and Director of the Kennedy
Institute of Ethics at the same University, is a
recognized expert in the field of medical
ethics. In his Killam Memorial Lecture at
Dalhousie University on October 24, 1985, Dr.
Pellegrino said that until 20 to 25 years ago
(i.e. between 1960 and 1965), during the 2,500
year history of medical ethics, the decision as
to choice of treatment was made by the physician
alone. The physician was the final authority
both technically and morally, and his decision
was not questioned.
(5) Thalidomide : The thalidomide disaster of the
early 1960's opened the eyes of both the public
and the medical profession to the tremendous
dangers that new drugs (and by extension, other
treatments) could pose if not carefully tested
before being used on humans. After the shock of
thalidomide, the public and the medical pro-
fession alike began to give much more attention
to the unknown effects of medical treatments
generally and drugs in particular.
The changes in society's thinking brought about by these
developments and others like them have been rapid and
profound. All of them occurred after Dr. Cameron retired
from the Allan, or just at the end of his tenure there.
It is difficult now to step back from the new environment
created by these developments and look at the matter
through the spectacles of the 1950's and early 1960's, but
it is essential to do so if we are to render a true
judgment. Neither legally nor morally should we impose
today's standards in the matters of consent and choice of
treatment upon the actions of those who in good faith
conducted themselves in accordance with the laws and the
ethics of the day.
- 95 -
7. THE INVOLVEMENT OF THE CIA
A. General conclusion
There is no doubt that the CIA funded Dr. Cameron to
conduct research work at the AMI in the field of psychic
driving, in combination with the usual concomitants of
depatterning, sleep therapy, sensory isolation and drugs.
Total funding apparently amounted to $84,820 and was
spread over six years, from 1957 to 1962. (See Tab H of
the Affidavit of John Marks in the Orl ikow case, sworn
April 30, 1981, attached at Appendix 44; there is con-
flicting information within Tabs G and H as to the exact
time frame of the funding and the amounts involved, but it
will be assumed for purposes of this opinion that the
later date (1962) and the higher amount (stated above),
In preparing this opinion, I have not had access to CIA
file materials, other than the publicly available informa-
tion specifically referred to. Nor have I had access to
patient's records. Because of these limitations to my
mandate, it is impossible to reach a conclusion as to what
role (if any) the CIA actually played in instigating,
directing and controlling the treatments given to individ-
ual patients. It follows that any inferences I may draw
in this regard are necessarily tentative and speculative.
What is clear, however, is that the allegations as to
treatments made by the nine U.S. plaintiffs are consistent
with the supposition that the CIA was only involved in
funding and was not involved in instigating, directing and
controlling Cameron's work; and that Cameron was simply
applying treatments of a kind which, by the time he
applied for funding from the Society for the Investigation
of Human Ecology (the CIA "cover" organization), had
become standard practice for him. This conclusion is
based on a comparison of the procedures alleged generally
by the nine U.S. plaintiffs, with those in general use at
the time at the Allan; it will be appreciated that, in the
absence of patient's records, no conclusion can be drawn
as to the propriety of any particular treatment in the
case of any particular plaintiff.
Because questions about what happened at the AMI can be
answered without reference to the CIA's role, it follows
that in a sense, the CIA's role is a side issue in
reaching the conclusions arrived at in the rest of this
section of this opinion. I have, however, considered it
important to discuss this role, both to explain how I
arrived at these conclusions, and because of your request
that I address the question of the government's wider
(i.e. extra-legal) responsibilities - a question which, in
view of the public attention which has been paid to the
matter of CIA involvement, cannot be fully addressed with-
out reference to what is known about that involvement.
B. The context of the times
During World War II, scientists from the United Kingdom,
United States and Canada had cooperated to the fullest
possible extent. This cooperation continued in a quite
natural way for a long period after the war, heightened by
the engagement of the three countries in the Korean War of
the early 1950 ' s.
The June 1, 1951 meeting that took place in the Ritz
Carlton Hotel in Montreal, described in section 3 of this
opinion, was the starting point for cooperative effort
among the three countries in defence-related research into
problems of the mind. As a direct result came the
research on the effects of sensory deprivation carried out
by Dr. Donald O. Hebb at McGill.
C. Understanding between Canada and the U.S.
At that time, so I am advised by Dr. Solandt, Chairman of
the Defence Research Board from 1946 to 1957, there was an
unwritten understanding between DRB (including the Chiefs
of Staff of the Canadian Services, who were members of the
DRB), and their opposite numbers in the U.S. Defence
Department and all three U.S. Services, on the subject of
classified defence-related research. It was agreed that
neither government would fund defence research of a
classified nature that was to take place in the other
country. Instead, if (for example) the U.S. wanted to
have some research done in a particular field, and
considered the work could best be done in Canada, they
would inform the DRB,and if the DRB considered that the
project fell within its mandate and was not unsuitable on
some other ground, then the DRB would fund the research
directly itself. The U.S. did not directly reimburse
Canada for this work but there was a rough quid pro quo in
that, when Canada requested the U.S. to do certain work in
exchange, the work would be done south of the border and
at U.S. cost.
The reason for this arrangement was so that Canadian
researchers would not be placed in the position of being
under a duty of confidentiality to a foreign government
concerning the results of the classified research, and as
a result be unable to transmit the results to their own
Dr. Solandt has advised me that on a couple of occasions,
U.S. government agencies made plans to, or actually
attempted to, fund classified research in Canada directly,
in contravention of this unwritten understanding. I am
not clear whether this was done deliberately or by
mistake, but in any event the plans or attempts were
discovered and the projects were either terminated or
continued by the DRB in collaboration with the U.S. Agency
that needed to have the work done in Canada.
I asked Dr. Solandt whether the unwritten understanding
extended to unclassified work funded by defence agencies
of the U.S. government. While strictly speaking it did
not, Dr. Solandt said that Canada would have taken "a
pretty dim view" of attempts by U.S. defence agencies to
fund research without checking with the DRB, even if that
research was not of a classified nature.
Dr. Solandt had not heard of the Society for the Investi-
gation of Human Ecology, nor had he heard of any CIA fund-
ing of research projects in Canada and in particular Dr.
Cameron's work at the AMI until reading the newspaper
reports of the past few years. Had he known of such fund-
ing at the time when he was in the public service he would
have disapproved of it, even though Dr. Cameron's work was
unclassified, on the basis that such funding ran counter
to basic understandings even if not counter to the parti-
cular unwritten understanding that obtained with respect
to classified research.
There was of course, and continues to be, a great deal of
openly acknowledged funding of unclassified research in
Canada on the part of U.S. government agencies. These in-
clude the U.S. Surgeon General, the U.S. Armed Forces, and
the National Institutes of Health. The point is simply
that, in Dr. Solandt's view, the ultimate source of fund-
ing for such work should indeed be openly acknowledged.
D . The Society for the Investigation of Human Ecology
The next matter to consider is the composition and prac-
tices of the Society for the Investigation of Human Eco-
logy. In accordance with my mandate I have not made any
enquiries in the U.S. For what follows I have relied on
publicly available information most of which I have
located in Canadian Government files.
The Society for Investigation of Human Ecology, Incor-
porated ("SIHE") was a research funding agency based in
New York City. It was incorporated in 1955 by Dr. Harold
Wolff, a neurologist at Cornell Medical School, with
himself as President. In 1961 the Society changed its
name to the Human Ecology Fund, Inc. It received its
funds from a number of "legitimate" sources, and was also
used as a "cover organization" through which the CIA
funded research projects in which it had an interest. The
CIA closed down the "front" in 1965.
The Executive Director of the Society was Colonel James
L. Monroe. His salary was paid by the CIA, according to
John Marks, author of "The CIA and Mind Control: The
Search for the 'Manchurian Candidate'" (McGraw-Hill,
1980). CIA documents confirm that the Cameron project was
to be monitored by Monroe: see Appendix 45, para. 9(2).
Monroe visited Dr. Cameron in Montreal while supervising
the grant. (See letter of Colonel Monroe at Appendix 45A;
see also Appendix 44, Tab E, where Leonard Rubenstein (an
associate of Cameron's in the CIA-funded project) says he
remembers meeting Monroe). Colonel Monroe has stated that
only 25-30% of the Society's funding came from the CIA
(Tab E, Appendix 44), but in a newspaper article at the
same tab. Dr. Lawrence Hinkle, a former director of the
Society, says most of the support came from the CIA; and
in his book Marks puts the actual figure at over 90%.
However this may be, it is clear from U.S. government
statements that the CIA was involved with Dr. Cameron's
research, and for purposes of this opinion I have assumed
that all of such funds originated with the CIA. This
conclusion seems to be borne out by the CIA materials at
A brief word on the background of the MK Ultra program is
in order. MK Ultra was the name given to an extensive CIA
program of research into behavioural modification, includ-
ing the use of drugs and other *-.echniques . The psychic
driving research which Dr. Cameron carried out with SIHE
grant money was designated by the CIA as "MK Ultra Sub-
E . Dr. Cameron's grant application to the SIHE
On January 21 , 1957, Dr. Cameron made his application to
the SIHE for a grant for $19,090 for two years. The
application is attached as Appendix 18. In it will be-
seen reference to the psychiatric procedures under review
here. What is clear both from this application and from
the scientific literature is that Cameron had certainly
developed and put into practice the techniques of depat-
terning and psychic driving a number of years before he
made his application to the SIHE. He stated in his appli-
cation that the "first objective" of the SIHE research was
to improve the psychic driving technique. The use of
specific drugs, including curare, to "inactivate the
patient" during driving was mentioned. The use of LSD 25
to "break down ongoing patterns of behaviour" was also
mentioned. The "second objective" was to measure the
amenability to change of certain physiological functions
as a consequence of the repetition of verbal signals. The
original application was granted and then extended for two
further years. Altogether, as stated above, Cameron
received the sum of $84,820 (or rather the AMI received
this sum, because Cameron's application specified that
there was to be no remuneration for himself.)
It should be noted here that, with one exception, no one I
spoke to had ever heard of the SIHE, or of any CIA funding
of research in Canada, in particular research at the AMI,
until reading about it in the newspapers in the late
1970's and early 1980's. One person. Dr. Ruth Hoyt,
was once asked at McGill in the 1950's, by persons not
remembered, if she had heard any rumours about CIA funding
of Dr. Cameron's research. She had not.
F. The position of the U.S. government
The position of the U.S. government is that, while they
acknowledge the grant from the SIHE to the AMI, and the
CIA participation in the SIHE, the CIA did nothing more
than fund an ongoing program of research. They deny that
the CIA in any way instigated or controlled or directed
Dr. Cameron in his work. They were simply interested in
seeing the research program carried out and in obtaining
the results. A Note from the U.S. Embassy on this point
is attached as Appendix 48.
G. T he CIA and Dr. Cameron's research activities
The question next arises, did the CIA direct, control or
guide Cameron's research activities in such a way that the
"treatments” administered to patients were not intended to
be for their benefit, but instead were intended to be pure
experiments on unwilling and unwitting victims?
In attempting to answer this, one must first look at the
prior question: Did Cameron even know that the CIA was
behind the grant from the SIHE?
In the first place, I have seen no direct evidence that
this was Cameron's purpose. It might be argued that the
fact that Cameron carried out these highly intrusive and
intensive procedures at all constitutes such direct evi-
dence, especially in view of the fact that they did not
work. But such evidence is equally consistent with the
conclusion that Cameron's procedures were intended to be
of benefit to his patients. The fact that they did not
work is not proof of anything sinister, as there have
always been and always will be cases of medical misadven-
ture, where new techniques have been tried and have fail-
ed. Such evidence is also consistent with the suggestion
that the CIA was interested in merely supporting on-going
research in areas of interest to it. It is easy to ima-
gine why Cameron's research into the techniques of psychic
driving would be of interest to the CIA in the context of
its MK Ultra program, even if such research was not con-
trolled or directed by the CIA.
Second, all of the medical people with whom I spoke were
strongly inclined to doubt it, as were almost all the
other's I spoke to.
Third, the indirect evidence seems to me to point to the
conclusion that CIA control of Cameron's work is quite
unlikely. The following considerations suggest this con-
(1) It is difficult to believe that an agent of the
CIA bent on performing "brainwashing" experi-
ments on unwilling and unwitting victims could
keep his excesses and ultimate purposes secret
from the other psychiatrists, nurses and staff
at the AMI.
(2) All of the procedures in the sensitive areas -
depatterning , psychic driving, sensory
isolation, sleep therapy and psychopharmacology
- were in fact in use by Cameron long before the
CIA became involved. The SIHE application only
proposed improvements in existing psychic
driving procedures. This is clear on the face
of Cameron's application to the CIA (see
Appendix 18) as well as from Cameron's published
literature. Indeed, at least one of the nine
U.S. plaintiffs (Mr. Robert Logie) appears to
have been in and out of the AMI before the
application to the SIHE for funding was made
(Sunday Star, Aug. 18, 1985).
(3) Not only were these procedures widely used, but
they were widely written about, both in the
scientific and medical journals and in the
popular press. Cameron never made any attempt
to keep his work secret; indeed he flaunted its
see for example the newspaper article at
Appendix 48A. He believed in the importance of
communicating his work to the public, so as to
create a good name for his Institute and for
psychiatry in general. It seems to me a servant
of the CIA would have kept a lower profile.
(4) In at least three of his publications, Cameron
did acknowledge the SIHE's funding of his work
(Appendices 9, 11 and 14); it seems unlikely to
me that he would give this public acknowledge-
ment if he knew all along the CIA was behind
SIHE's funding of the project. Moreover, the
SIHE in turn referred in public reports to the
work Cameron was doing in psychic driving: See
Appendix 44, Tab G. (On the other hand, it
might be argued that such public acknowledgement
of a funding source constituted part of the
(5) Cameron, in fact, put a stop to what he regarded
as excessive use of massive electroshock by one
of his associates. This point is discussed by
Dr. Cleghorn in Appendix 36, Part II, p.71 and
pp. 88-89. It seems unlikely to me that someone
whose purpose was to destroy other peoples'
minds so that he could give the results secretly
to the CIA would be troubled by the excesses of
a fellow psychiatrist working with him at the
(6) At least two of Cameron's H&W projects. Nos.
604-5-14 (1950-1954; $17,875.00) and 604-5-432
(1961-1964; $51,860.00) had to do with the same
subject matter as the SIHE research. One of
these projects was completed three years before
the SIHE application was made; the second began
as the SIHE project was coming to a close.
These facts suggest that SIHE project was simply
part of a continuing program of research into
new psychiatric methods.
(7) A number of documents suggest he did not know of
(a) The internal CIA document at Appendix 45
states as follows:
"9. In view of the fact that McGill
University is in Canada, the following
security consideration should be noted:
( 1 ) Dr. Cameron, the principal investi -
gator, and his staff will remain
completely unwitting of U.S. Government
(2) The project will be monitored by Col.
James Monroe, staff member of the
(3) No Agency staff personnel will contact,
visit or discuss this project with Dr.
Cameron or his staff under extreme
(4) If it is necessary for Agency personnel
to contact Dr. Cameron or his staff,
the matter will be discussed with the
Office of Security and the desk
involved for their evaluation and
advice as to the proper procedures to
be taken." (emphasis added)
(b) John Marks, in his book "The Search for the
'Manchurian Candidate': The CIA and Mind
Control", McGraw-Hill, 1980, states in a
footnote at p.133:
"Cameron himself may not have known that
the Agency was the ultimate source of
these funds which came through a
conduit, the Society for the Investi-
gation of Human Ecology. A CIA document
stated he was unwitting when the grants
started in 1957, and it cannot be said
whether he ever found out."
Chapter 8 of Marks' book, which deals at
length with Cameron's work, is attached at
Appendix 46. Mark's request under the U . S
Freedom of Information Act was the origin of
much of the subsequent press interest in
(c) In his testimony of August 3, 1977 before
the United States Senate, Mr. John
Gittinger, a former psychologist with the
CIA, stated (see Appendix 44 Tab F):
"The Agency in effect provided the
money. They did not direct the
projects. Now, the fact of the matter
is, there are a lot of innocent people
who received the Society for the
Investigation of Human Ecology money
which I know for a fact they were never
asked to do anything for the CIA but
they did get through this indirectly.
They had no knowledge they were getting
"I will say it was after the fact
thinking. It was utter stupidity the
way things worked out to have used some
of this money outside the United States
when it was CIA money. I can categor-
ically state to my knowledge all the way
across of the human ecology functions,
but to my knowledge, and this is
unfortunate, those people did not know
that they were getting money from the
CIA, and they were not asked to con-
tribute anything to CIA as such."
(d) The U.S. government has said that available
evidence indicates that Cameron and his
staff did not know of CIA involvement: See
- 110 -
Leonard Rubenstein, one of Cameron's
colleagues in the SIHE research, has stated
that he knew of no CIA connection: See
Appendix 44, Tab E.
(f) An External Affairs memorandum to file dated
March 1, 1984 suggests that a person (name
deleted, but presumably a colleague of Dr.
Cameron) was unaware of CIA involvement:
See Appendix 47.
On the other hand, on the CBC television show "Fifth
Estate", Mr. James Turner, law partner of Mr. Joseph L.
Rauh, U.S. attorney for the nine Canadian plaintiffs who
have brought suit against the CIA, states that Mr.
Gittinger caused a representative of the CIA to telephone
Cameron at the AMI and invite him to apply to the SIHE for
funding, informing him that the funds originated from the
CIA. I have not of course seen the basis for Mr. Turner's
statement, and thus I cannot verify or refute this claim.
It is of course intellectually conceivable that, at
bottom, Cameron was a mad scientist, conducting experi-
ments on unwilling and unwitting victims for some purpose
other than the ultimate benefit of his patients and at the
bidding of some third party like the CIA. But in my view
this conclusion is unlikely for all of the reasons given
In my opinion, it is more likely that the CIA was simply
interested in "buying results" in ongoing research which
it in no way controlled or directed. In drawing these
inferences I am supported by the view of the former
President of McGill, Dr. Bell, who had the matter looked
into from a university perspective in 1979 (See Appendix
Finally, it may be asked whether it makes any difference
even if Cameron did know that the CIA was behind the
SIHE's funding. In the cold war climate of late 1950's,
accepting a research grant from the secret service agency
of a friendly country would not carry the sinister over-
tones it does today. The CIA was not as much tarred with
the "dirty tricks" brush as it is today. If therefore
Cameron did know of CIA involvement, that fact standing
alone does not seem to me to be proof of ill intent. Like
many scientists, Cameron would take grant money wherever
he could find it without taint: Appendix 47 touches this
point. Given the climate of the times therefore, one
might well conclude that Cameron believed the CIA's money
was indeed untainted, that he accepted it in good faith,
and that to prove fault it would be necessary to show in
addition that Cameron had agreed to, and in fact did,
carry out secret, non-therapeutic experiments on the minds
of unwilling and unwitting victims.
If the inferences in the above two paragraphs are correct,
it follows that the whole question of CIA involvement is a
red herring in so far as this opinion is concerned. The
issue here is not whether the CIA ultimately funded some
of the work of the AMI; the issue is whether the work that
Cameron did was proper or improper, and whether the
Canadian government as one of the granting agencies to the
AMI bears any responsibility in the event such work is
found to be improper.
In saying this, I am of course conscious of the fact that
the CIA funding does raise extremely grave questions about
the violation of Canadian sovereignty by a foreign govern-
ment. But however important, these questions raise quite
separate issues, and they should not be confused with the
issue with which I am dealing.
In accordance with my mandate, I have not addressed these
In reaching these conclusions I repeat that I have not
seen any information from CIA files in the possession of
the U.S. other than the publicly available information
referred to above. Consequently, my inferences concerning
Cameron's involvement with the CIA are tentative and
speculative, and may well need to be changed should the
Canadian government take up the proposal of the U.S.
Secretary of State that the CIA files be reviewed by
Canadian officials, or should other information come to
light from other U.S. or Canadian sources. (It may even
be argued that the internal CIA memorandum of October 31 ,
1978 from its General Counsel to Robert H. Wiltse,
attached at Appendix 48C, itself suggests a conclusion
opposed to that which I have reached; but this memorandum
standing alone does not, in my view, assist one way or the
8. THE ORLIKOW AND MORROW CASES
Mrs. Velma Orlikow and Dr. Mary Morrow, two of the plain-
tiffs in the U.S. lawsuit, also brought action in Quebec
in respect of the treatments they had received at the
Allan. Summaries of the two cases are attached at Appen-
dices 49 and 50 respectively.
A. The Orlikow case
Mrs. Orlikow 's case was commenced in April, 1979 and was
settled out of court after evidence was given but before a
judgment was rendered. Media reports suggest a settlement
figure of $50,000, being the amount of the fees paid by
Mrs. Orlikow to the Allan.
What is clear from the evidence is that Mrs. Orlikow had
been quite seriously ill since 1951, having been treated
with little or no improvement by a number of profession-
als, including staff at the Mayo Clinic. These treatments
included psychotherapy, electroshock treatment and drugs,
including Largactil. She came to Dr. Cameron in November,
1956 on the recommendation of her physician in Winnipeg,
and remained a patient of Dr. Cameron off and on until
May, 1964. Following Dr. Cameron's retirement from the
Allan in 1964, Mrs. Orlikow continued to visit him at his
Lake Placid home. While under Dr. Cameron's care she
allegedly underwent depatterning , sensory deprivation,
psychic driving and psychopharmacolog ical treatments,
including LSD, sodium amytal , desoxyn and Largactil.
The expert psychiatric evidence presented at the trial is
in conflict. Mrs. Orlikow' s expert, Dr. Paul-Hus, testi-
fied that Cameron's treatments were "very unusual" and of
an experimental nature. Dr. Alan Mann, the defendant's
expert, in effect agreed that in general psychic driving
and electroshock treatments did not work in the manner in
which they were then applied, but said that both proce-
dures (i.e. replay of taped messages and electroshock
therapy) are still in use, though in a different way. He
said in effect that one had to make allowances for the
fact that much less was known in the 1950's and early
1960's about how to treat the mentally ill, and it was in
light of this lack of knowledge coupled with a strong
desire to conquer the suffering of the mentally ill that
one must judge Dr. Cameron's treatments.
In view of the fact that there are no judicial findings of
fact in the Orlikow case, conclusions from it are diffi-
cult or impossible to draw, and I have drawn none for
purposes of this opinion.
B. The Morrow case
Dr. Mary Morrow is a psychiatrist who formerly worked for
Dr. Cameron at the Allan and had assisted him in admini-
stering depatterning treatments to patients there. In
1960 she herself became a patient of Dr. Cameron, and
received electroshock treatments towards depatterning. In
1967 she brought action for damages against the Royal
Victoria Hospital and the estate of Dr. Cameron.
In a 1978 judgment of the Quebec Superior Court, her
action was dismissed.
In January, 1985 the Quebec Court of Appeal permitted Dr.
Morrow to re-open the case and to introduce new evidence
not available at the time of the original trial, to the
effect that the CIA funded Cameron to carry out brain-
washing on patients. This evidence has now been submitted
to the Clerk of the Court. I understand, however, that it
will be at least eighteen months before the court hears
the appeal based on this new evidence.
The trial judgment concludes, in effect, that there was no
wrong-doing by Dr. Cameron, that intensive electroshock
was a standard procedure at the time, and that Dr. Morrow
had given full consent to the treatments.
In view of the strong judgment of Bourgeois, J. of the
Quebec Superior Court, reached after hearing extensive
expert evidence (including that of Dr. Robert Cleghorn
who, incidentally, was called to the stand by the Plain-
tiff but whose evidence strongly favoured the Defendant),
I conclude that this case stands as a strong precedent, at
least on intensive electroshock therapy, and at least
until the Quebec Court of Appeal renders its decision.
Since the new evidence taken last year on the subject of
the CIA's funding of Cameron's research is privileged, I
have not had an opportunity to review it. I am therefore
not in a position to predict how the Court of Appeal will
decide. Depending on how the court decides and on the
basis of what evidence, the result could well provide a
very strong precedent at the Appeal Court level, both on
the question of intensive electroshock therapy and on the
conclusions to be drawn from CIA involvement in funding
research at the Allan.
9. LEGAL PRINCIPLES APPLICABLE TO THIS CASE, AND
CONCLUSIONS OF LAW
A. Preliminary assumption
A complete discussion of the applicable legal principles,
authorities and my conclusions thereon will be found at
Appendix 51. These conclusions are based on the assump-
tion that a potential plaintiff could prove Dr. Cameron's
conduct to be tortious in the first instance. In my
opinion, this assumption is not warranted. While the
matter is not free from doubt, and (as explained above in
section 5) would be the subject of controversy among
psychiatrists, in my opinion the weight of evidence and of
legal precedent points to the conclusion that no tortious
liability would be found to exist if the matter were
litigated. Of course, in stating this I am assuming that
such litigation would be decided on the general question
of whether Cameron's procedures were proper or improper in
themselves given the climate and knowledge of the times,
and would not turn on such questions as whether the parti-
cular treatments used in the case of a particular plain-
tiff were appropriate for that individual or, if so,
whether the treatments were carried out in a negligent or
a proper manner.
In reaching this conclusion I have relied on the expert
opinions of Drs. Grunberg , McDonald and Lowy, as well as
on the factual analysis set out in the foregoing sections
of this opinion.
If this analysis is correct, and a plaintiff could not
establish legal liability against the Allan or the estate
of Dr. Cameron, or some other person having responsibility
for a plaintiff's treatment, then a fortiori no legal lia-
bility can be established as against the Crown.
B. Legal analysis
Assuming, however, that the foregoing analysis is incor-
rect, and that a plaintiff could prove tortious conduct as
against the Allan or some other party, the question still
arises as to whether the Crown is legally liable by reason
of having funded certain of the research work of Dr.
Cameron and the Allan. I have reached the conclusion that
the Crown would not be liable, for the reasons set out in
Appendix 51. The following is a brief summary of those
The Crown is liable only under the conditions prescribed
in the Crown Liability Act . In the context of this case
it must be shown that a servant or agent of the Crown
caused damage by his fault or was liable in tort. A
potential plaintiff might advance three arguments:
( 1 ) Servant or agent of the Crown
It might be argued that Dr. Cameron was a
servant or agent of the Crown for whose torts or
delicts the Crown is vicariously liable. The
evidence shows clearly that Dr. Cameron was
neither a servant nor an agent of the Crown.
Consequently the Crown cannot be liable on that
(2) Authorization or ratification
It might also be contended that the tortious
conduct of Dr. Cameron was authorized or
ratified by servants or agents of the Crown. By
using this analysis a potential plaintiff would
endeavour to attach secondary liability to the
servant or agent and thereby fix vicarious
liability on the Crown. Secondary liability,
whether by way of authorisation or ratification,
is imposed only where the person sought to be
made secondarily liable possesses knowledge that
the acts alleged to have been authorised or
ratified were tortious in nature. The evidence
here is, however, bereft of any suggestion that
any governmental official, whether servant or
agent, knew of the tortious character of Dr.
Cameron's research and treatment (assuming such
tortious character could be proved in the first
instance). It therefore follows that this
approach would not result in a finding that the
Crown was legally liable in respect of Dr.
(3) Duty to control
The third avenue of attack for potential
plaintiffs is to assert that a servant or agent
of the Crown owed a duty to them to control the
conduct of Dr. Cameron. The courts have recently
enlarged the concept of "duty" in cases of this
kind. A plaintiff could now arguably maintain
that there is some legal basis upon which a
granting agency might be legally liable to the
patient in the event medical research goes
wrong. (It is interesting to note that the
National Cancer Institute of Canada has recently
decided to require grantees and their insti-
tutions to sign forms of indemnity by which the
NCI is held harmless in the event suit is
brought against it for the research activities
of its grantees: See Appendix 52 attached.)
Although this expansion of the concept of duty
has probably not yet run its full course in the
courts, and may well in future years be
developed to the point where plaintiffs might
succeed in a case of this kind, I do not
consider that the law as it presently stands
would permit a plaintiff to recover. My reasons
The courts recognize such a duty only in two
types of case:
(i) where there is a "special relationship"
between the defendant on whom such a duty
is sought to be imposed and the third
party, here Dr. Cameron, and
(ii) where there is a "special relationship"
between the defendant and the plaintiff.
In the first case, there is a "special relation-
ship" (and a duty is imposed) only where there
is a right and ability to control the third
party. The provision of research funds to Dr.
Cameron does not carry with it a "right and
ability" to control him, and thus there was no
"special relationship" between the Crown and
As for the second case, there is no "special
relationship" between a potential plaintiff and
It therefore follows that in the circumstances the Crown
is not legally liable for the conduct of Dr. Cameron,
assuming such conduct could be proved tortious in the
D. Limitation of Actions or Prescription
The legal analysis above and in Appendix 51 has been
carried out without regard to the provisions of any
applicable law limiting the right of a plaintiff to bring
action because of the passage of time.
E. Civil Law
Mr. James M. Mabbutt, Counsel, Constitutional and
International Law, Department of Justice has reviewed
Appendix 51 and has confirmed that, from a Quebec civil
law viewpoint, the conceptual analysis is complete and
accurate and supports the conclusion of no delictual
liability. While I take responsibility for the legal
research necessary to formulate this opinion, I am not
qualified to practice in the Province of Quebec, and I
have therefore relied on Mr. Mabbutt' s opinion in so far
as conclusions stated herein are controlled by the law of
10. THE WIDER RESPONSIBILITIES OF GOVERNMENT
A. Further discussion of the "penultimate question"
- whether Dr. Cameron's treatments were proper or
Two points arise here: whether the treatments were
irresponsible or reckless even on the assumption Cameron
had no knowledge of CIA involvement; and the question of
On the first point. Dr. Cameron must have known that the
large doses of electric shock applied in the depatterning
procedure, and the large number of seizures produced,
could result in brain damage. It was well known at the
time for example that epileptics subjected to many
seizures often suffered brain damage. And psychic driving
was largely untried.
On the other hand, it would appear that the patients
selected for these treatments were very disturbed, and
that other psychiatric procedures had failed to help
them. To the extent that patients' individual medical
records might show on examination that some individuals
who were not severely disturbed were subjected to the
treatment, then for such cases it might be said that the
treatments bordered on the irresponsible. I of course
have not seen, nor have I sought, information relating to
any of the former patients at the Allan, and consequently
any conclusions would be in the realm of speculation.
Given the standards of the time, and allowing for his
ambition, and based on the interviews I have conducted,
the files I have reviewed and especially on the opinion of
the three experts with whom I have consulted, I have
reached the view that Dr. Cameron was operating within
those standards. Perhaps the conclusion that comes
closest to the truth is that he acted incautiously, but
not irresponsibly. Most psychiatrists did not make the
mistakes he did in developing and applying the depat-
terning and psychic driving techniques, but this was out
of a sense of caution in the face of the highly intrusive
and extremely intensive nature of the treatments.
As for the second point, all medical treatments (even
aspirin) involve a balancing of pros and cons, an exercise
of judgment. Very few treatments are wholly innocuous. A
patient is entitled to a physician's judgment, exercised
on behalf of the patient and no one else, as to whether
the proposed treatment constitutes a reasonable
"cost-benefit". Were Dr. Cameron's assessments carried
out on the patients' behalf, or for other purposes? I
have not seen enough evidence to allow a factual
conclusion to be drawn on this point; and of course one
cannot read the heart, even after all the evidence is in.
In my view, the evidence that is available is consistent
with the conclusion that he did in fact exercise his
judgement on his patients' behalf.
B. The "ultimate" question — the Crown's
I turn now to the ultimate question. Let us assume, con-
trary to my own conclusion, that Dr. Cameron did in fact
carry out procedures on patients for some purpose other
than the patients' benefit. Alternatively, and less
menacingly, let us assume that Dr. Cameron did in fact
blur the distinctions among experimentation, new
techniques intended to be therapeutic (therapeutic
trials), and routine treatment. Let us further assume in
both cases that some individual patients were not helped
but suffered damage. On these assumptions, the question
is: Does the Government of Canada bear any moral res-
ponsibility towards those patients?
In my opinion, given the climate of the times, and the
prevailing practices as to medical research and experimen-
tation, ethics and consent, the Government of Canada can-
not be expected to bear responsibility for what happened
at the AMI, even assuming (contrary to my own conclusion
on the point) that Dr. Cameron crossed over the line of
the acceptable in medical research. The government's
research grants were at all times subject to reviews both
internal and external; no adverse comments were brought
to the attention of those responsible.
The granting agencies did not know - and could not know -
of any ulterior motive on Cameron's part (assuming there
was one). Nor, given the way these questions were common-
ly dealt with at the time, did they know - or could they
know - of any failure on Dr. Cameron's part to observe the
distinctions among experimentation, therapeutic trials and
It is difficult to see how moral responsibility can lie on
the government in such a situation.
In Appendix 53 will be found a discussion of the question
of compensation in the absence of legal or moral responsi-
11. FINAL CONCLUSIONS
For the reasons stated in sections 9 and 10, in my opinion
the Government of Canada bears no legal or moral responsi-
bility for the activities of Dr. D. Ewen Cameron. I
repeat that this conclusion does not mean that no one has
a cause of action on the ground that some particular
course of treatment was inappropriate for the illness
being treated, or inexpertly or improperly administered.
I will conclude with a statement of Lord Denning, M.R., a
statement roughly contemporaneous with the matters in
issue here, in Roe v. Minister of Health ,  2 Q.B.
66, at pp. 83-84, cited by Bourgeois, J. in the Morrow
"It is so easy to be wise after the event and to
condemn as negligent that which was only a
misadventure. We ought always to be on our guard
against it, especially in cases against hospitals
and doctors. Medical science has conferred great
benefits on mankind, but these benefits are attended
by considerable risks. We cannot take the benefits
without taking the risks. Every advance in
technique is also attended by risks. Doctors, like
the rest of us, have to learn by experience; and
experience often teaches in a hard way. Something
goes wrong and shows up a weakness, and then it is
put right. That is just what happened here. Dr.
Graham sought to escape the danger of infection by
disinfecting the ampoule. In escaping the known
danger he unfortunately ran into another danger. He
did not know that there could be undetectable
cracks, but it was not negligent for him not to know
it at that time. We must not look at the 1947
accident with 1954 spectacles."
and later, at pp. 86-87:
"One final word. These two men have suffered such
terrible consequences that there is a natural
feeling that they should be compensated. But we
should be doing a disservice to the community at
large if we were to impose liability on hospitals
and doctors for everything that happens to go
wrong. Doctors would be led to think more of their
own safety than of the good of their patients.
Initiative would be stifled and confidence shaken.
A proper sense of proportion requires us to have
regard to the conditions in which hospitals and
doctors have to work. We must insist on due care
for the patient at every point, but we must not
condemn as negligence that which is only a
In my view, this passage is particularly appropriate in
the circumstances under review in this opinion.
Yours very truly.
Appendices 4, 5 and 6 are reproduced with this opinion.
The full appendices are available at the following
Department of Justice Regional Offices
Medical Faculty libraries
Major Municipal Libraries
LIST OP APPENDICES
1. Plaintiffs' Second Amended Complaint in US Lawsuit -
June 3 , 1983
1A. Letter from plaintiffs' attorney detailing basis for
plaintiffs' claim - February 24, 1984
2. List of persons interviewed
3. List of files reviewed
4 . Expert opinion and C.V. of Dr. Frederick Grunberg
5. Expert opinion and C.V. of Dr. Ian M. McDonald
6. Expert opinion and C.V. of Dr. Fred H. Lowy
7. D. EWEN CAMERON - Psychic Driving. American Journal
of Psychiatry, 112 (7), 1956
8. D. EWEN CAMERON - Psychic Driving: Dynamic Implant.
Psychiatric Quart. 31: 703-712, 1957
9. D. EWEN CAMERON & ROBERT B. MALMO - Effect of
Repeated Verbal Stimulation upon a Flexor-extensor
Relationship. Canadian Psychiatric Association
Journal, Vol. 3, No. 2, April 1958
10. D. EWEN CAMERON & S.K. PANDE - Treatment of the
Chronic Paranoid Schizophrenic Patient, Canada
M.A.J. Jan. 15, 1958, Vol. 78, pp. 92-95
11. D. EWEN CAMERON, LEONARD LEVY, L. RUBENSTEIN & R.B.
MALMO - Repetition of Verbal Signals: Behavioural
and Physiological Changes. American Journal of
Psychiatry, 115 (11), 1959
12. D. EWEN CAMERON, LEONARD LEVY & LEONARD RUBENSTEIN
Effects of Repetition of Verbal Signals upon the
Behaviour of Chronic Psychoneurotic Patients.
J.Ment. Sci., 106, No. 443, April 1960
12A. D. EWEN CAMERON, Production of Differential Amnesia
as a Factor in the Treatment of Schizophrenia. Comp.
Psychiat. , Vol. 5, 1960, pp. 26-34
13. D. EWEN CAMERON, LEONARD LEVY, THOMAS BAN & LEONARD
RUBENSTEIN - Repetition of Verbal Signals in Therapy
Current Psychiatric Therapies, pp. 100-1 11, Ed. J.
Masserman, Grune & Stratton Inc., New York-London,
14. D. EWEN CAMERON, LEONARD LEVY, THOMAS BAN & LEONARD
RUBENSTEIN - A Further Report on the Effects of
Repetition of Verbal Signals Upon Human Behaviour.
Canadian Psychiatric Association Journal, Vol. 6,
No. 4, August 1961
15. D. EWEN CAMERON, J.G. LORENZ & K. A. HANDCOCK - The
Depatterning Treatment of Schizophrenia.
Comprehensive Psychiatry, Official Journal of the
American Psychopathological Association, Vol. 3,
No. 2, April 1962
16. D. EWEN CAMERON, LEONARD LEVY, THOMAS BAN & LEONARD
RUBENSTEIN - Automation of Psychotherapy.
Comprehensive Psychiatry, Official Journal of the
American Psychopathological Association, Vol. 5,
No . 1 , February 1964
17. L. LEVY, D.E. CAMERON, T. BAN & L. RUBENSTEIN - The
Effects of Long-term Repetition of Verbal Signals.
Canadian Psychiatric Association Journal, Vol. 10,
No. 4, August 1965
18. Dr. Cameron's grant application to the Society for
the Investigation of Human Ecology, Jan. 21, 1957
19. Extracts from and discussion of material in a
Ministerial Return by Hon. J. Waldo Monteith,
Minister of National Health and Welfare, on the
subject of LSD (undated: 1962 or 1963)
19A. NRC grants-in-aid for psychiatry
20. Report concerning communist "brainwashing" techniques
during the Korean War, Sept. 14, 1950
21. Minutes of June 1, 1951 Canada/US/UK meetinq re:
communist "brainwashing" techniques during the
22. DRB file materials on research by Dr. Donald 0. Hebb
on sensory deprivation experiments
23. DRB file materials, correspondence and news clippings
24. DRB report to Treasury Board, August 3, 1954
25. Letter from Dr. Cormier to Dr. Hebb, Dec.1, 1953
26. Health and Welfare application form and memoranda
on research grants
. HWC response to ATI request, showing nine Mental
Health Division research projects listing the name
of Dr. Ewen Cameron as principal investigator -
Apr i 1 5 , 1985
28. Final report on Project No. 604-5-14
29. Final report on Project No. 604-5-432
30. Summary of Project No. 604-5-13
31. File document and abstract on Project No. 604-5-74
32. Newspaper article - Dr. Heinz E. Lehman - May 16,
33. Memorandum to the Hon. Paul Martin, Jan. 18, 1949
34. Memorandum of Dr. Charles Roberts, April 8, 1953
35. Newspaper article - Dr. D.E. Cameron - May 15, 1957
36. Extracts from Dr. Robert A. Cleghorn's private papers
36A. Journal extracts on Dr. D.E. Cameron - 1965 and 1967
37. Extracts from paper by Dr. J.W. Fisher (undated: 1952
38. A.E. SHWARTZMAN & P.E. TERMANSEN - Intensive
Electroconvulsive Therapy: A Follow-up Study.
Canadian Psychiatric Association Journal, Vol.12,
No. 2, 1967
38A. Extract from Kalinowsky and Hoch, "Shock Treatments,
Psychosurgery and Other Treatments in Psychiatry" ,
39. "Ethics in Human Experimentation", Medical Research
Council of Canada's Working Group on Human
Experimentation, Report No. 6, 1978
40. Current MRC guidelines for grant application, and
51 . M
41. Application form of Dr. D. Ewen Cameron for Project
42. Consent forms, Orlikow and Morrow cases, and for two
other U.S. plaintiffs
43. "Patients 's Rights and Ethics Committee, Douglas I
Hospital Centre", by Wilson & Steibelt. Canada's
Mental Health, Vol.33, No. 3, September 1985
44. Affidavit of John Marks dated April 30, 1981, filed
in the Superior Court of Quebec in the Orlikow case
45. Internal CIA memorandum on MK Ultra Subproject 68,
Feb. 26, 1957
45A. Letter of Col. James L. Monroe to Dr. Cameron,
April 23, 1959
45B. Internal CIA documents on funding of MK Ultra
46. Chapter 8, "Brainwashing", from John Marks, "The CIA
and Mind Control: The Search for the 'Manchurian
Candidate'," McGraw-Hill, 1980
47. External Affairs memo to file, March 1, 1984
48. Note from the U.S. Embassy to Canada, April 12, 1984
48A. Newspaper article. Dr. D.E. Cameron, Calgary Herald,
May 15, 1957
48B. External Affairs letter of June 15, 1919 and
materials on McGill's view of Dr. Cameron's work
48C. Internal CIA memorandum from General Counsel to
Robert H. Wiltse, October 31, 1978
49. Summary of the Orlikow case
50. Summary of the Morrow case
51. Memorandum of law
52. Memorandum of the National Cancer Institute of
Canada, October, 1985
53. Memorandum on Compensation in the Absence of Legal or
REPORT TO GEORGE T.H. COOPER , Q.C.
I - THE WORK OF DR D.E. CAMERON
From the early fifties to the mid sixties. Dr D. Ewen
Cameron had been working at the Allan Memorial Institute of
Montreal on modifying the behaviour of chronic
psychoneurotic patients by utilizing a psychotherapeutic
procedure which he called "psychic driving" .
At the Illth annua! meeting of the American Psychiatric
Association in Atlantic City, May 11, 1955, Dr D.E. Cameron
read a paper entitled: "Psychic Driving: Dynamic
Implant" * in which he describes his psychotherapeutic
"Briefly , it is the exposure of the patient to continued
replaying , under controlled conditions , of a cue
communication derived from one of the original areas from
'jhich his current difficulties arise. A major consequence
of such exposure is to activate and bring progressively into
his awareness more recollections and responses generally
from this area. The ultimate result is the accelerating of
therapeutic reorganization" .
Subsequently, Dr D.E. Cameron and al read papers on this
subject at meetings of learned societies such as the
Canadian Psychiatric Association, the American Psychiatric
Association, the Royal Medico-Psychological Association, the
* This paper was subsequently published in Psychiatric Quart
31: 703-712, 1957.
World Congress of Psychiatry and published the results of
this work in journals such as the Canadian Psychiatric
Association Journal, the American Journal of Psychiatry and
the Journal of Mental Science. **
In two of his papers. Dr D.E. Cameron acknoledged the
assistance of grants from the Society for the Investigation
of Human Ecology and from Dominion-Provincial Mental Health
Grand Project no 604-5-432.
The description of the technique, the reporting of the
results, and the theoretical frame work of Dr D.E. Cameron's
work can best be found in my opinion in a chapter entitled:
"Repetition of verbal signals in Therapies" published
in "Current Psychiatric Therapies" Ed. J. Masserman, Greene
& Stratton, N.Y. - London, 1961. I shall summarize this
chapter with my personal comments in bracket.
A) THE PROCEDURE:
Chronic psychoneurotics who have failed to respond
to other methods of treatment.
(At that time particularly in North America the
treatment of choice of such patients was psycho-analysis
or psycho-analytically oriented psychotherapy. In
general 'Jith the techniques available at the time the
treatment vas long and expensive. Dr Cameron believed
that 'j)ith his technique he could reduce the length of
treatment and thus the cost. Furthermore I should add
that such patients are for the most competent and submit
to treatment on a voluntary basis).
** The reader will find in appendix I a bibliographical
listing of Dr D.E. Cameron publications on the subject.
a ) The conventional psychiatric interview or the
psychiatric interview carried out under
disinhibiting drugs together with a record of the
patient's evaluation of himself.
(Since the end of the second Morld Mar
desinhibit ing drugs such as sodium amytal a
barbiturate or desoxyin an amphetamine Mere often
used in the fifties to uncover repressed
psychological material or to obtain emotional
abreactions . I Mould add that in the fifties many
psychiatrists and psychologists Mere experimenting
Mith hallucinogenic drugs such as LSD 25 or
mescaline as desinhibit ing drugs or drugs that
could induce a model psychosis )
b) Social Service report.
c ) Psychological tests.
d) Movies taken in four differents and
e ) A battery of conditioned reflex tests.
f ) Electronic analysis of the voice.
(In spite of all the gadgetry none of those tests
could be considered intrusive Mith a potential for
harm ) .
3 . - Preparation of the patient.
Three principal methods of preparing the patient
were utilized by Dr Cameron.
a) The depatterning by means of prolonged sleep
and intensive electroshock.
b) Small doses of tubocurare in beeswax given
intra-muscularly to produce relative immobilization
on the part of the patient in order to maintain him
in the area of repetition.
c ) Putting the patient under an ordinary hospital
baker producing a relaxing degree of warmth.
(The preparation of the patient is may be the most
controversial aspect of Dr Cameron's procedure of
psychic driving because of its intrusiveness .
However Dr Cameron believed in the necessity >s>ith
the intractable psychoneurotic patient of breaking
do'Jn his long standing maladaptive patterns of
behaviour and thus facilitating the establishment
of ne'j) and more adaptive patterns by exposure to
repetition or psychic driving .
By today’s standards depatterning especially by
intensive electroshock is repugnant . However in
the context of the time the methods of psychiatric
treatment u )ere very intrusive particularly the
biological interventions such as Insulin Therapy
and continuous narcosis. It it true that those
intrusive methods uere utilized essentially u)ith
psychotic patients rather than vith the
psychoneurotics although prolonged sleep <jas uiuite
popular in Europe uith the latter).
4 . - The preparation of signals:
The material of the signals is derived from the
following sources: psychodynamic interviews,
reports from relatives, social service studies and
psychological tests. On the basis of all those
reports negative and positive statements are
prepared and recorded. The negative statements
face the patient with the neurotic difficulties
from which he has attempted to escape, while the
positive signals represent his aspiration tb be a
more effective person. They are phrased as far as
possible in terms of the patient’s own thoughts and
in the idiom he has used to express his hopes and
Presentation of signals:
These statements are recorded and played
continuously from 6 AM to 9 PM daily. During this
period the patient is lying in bed and listening to
the recording - which is fully audible - by means
of a pillow speaker. It is estimated that the
negative and positive signals combined are repeated
between 250,000 and 500,000 times during the course
of the exposure.
The negative signals which are run first are
ordinarely accepted by the patient during the first
few days but there gradually appears an increasing
degree of hostility towards them which reaches a
crescendo at the end of ten days. The patient is
then switched to the positive signals which he
accepts at once with a sense of relief and he
continues to demonstrate this satisfaction for a
varying period. However he soon becomes restless
and irritable, wanting to be up and around and
putting his new found behavioral pattern into
The period of exposure to the negative and positive
statements usually last about ten days each.
During the period of exposure to intensive psychic
driving the staff working with the patient are
briefed concerning the nature of the changes that
are being sought and instructed to give
encouragement and social acceptance on the
appearance of such changes. Concurrently the
Social Service Department works with the family in
an attempt to change their attitudes towards the
Once the intensive driving has been terminated, the
patient remains on positive driving from two to
four hours a day. During the remainder of the day
he works in occupational therapy where he is
encouraged by the staff to put into practice the
new behavioral pattern.
In many instances plans are made for the patient to
be discharged in selected foster homes rather than
in their own home for a period of three months
until a new behavioral pattern has been firmly
Subsequent to the patient's return home a
reassessment is carried out for a follow up period
of at least a year. The patient attends the
Institute and listen to his recording for at least
one hour twice or three times a week.
B) THE RESULTS:
In this paper. Dr Cameron reports:
"With regard to results in different categories of
illness Je may say that the extent of the changes jhich
ve have been able to produce in chronic schizophrenics
jas small. Our best results have been jith the chronic
psychoneurotics - and other vise untreatable patient -
patients , usually jith a long standing character
neurosis. With these patients our results have been
increasingly encouraging and je nou consider that the
procedure of our choice Jhen faced 'Jith such a cases".
C) THEORETICAL CONSIDERATION:
The work of Dr D.E. Cameron are based on the following
1) The human organism is exceptionally adaptive and
tends to respond to all in coming stimuli.
2) Exposure to constant repetition constitutes a
powerful force and from the uncontrolled effects of this
force the human organism attempts to protect itself.
3) There are a large number of mechanism, both at the
behavioral and at the neurophysiological levels which
exists simply for this purpose.
II ~ THE SCIENTIFIC VALUE OF DR D.E. CAMERON WORK
ON PSYCHIC DRIVING
The theoretical frame work of Dr D.E. Cameron is quite weak
and somewhat naive based on a over simplified extrapolation
of neurophysiological concepts to a complex behavioral
Also from a methodological stand point the testing of the
therapeutic value of this treatment was totally uncontrolled
based essentially on biased subjective evaluation and on
irrelevant pseudo-objective parameters such as movies taken
in four different and standardized situation, a battery of
conditioned reflex tests and the use of the plethysmograph
to measure skin resistance.
By to day standards this was bad science with heavy reliance
on gadgetry rather than on reflective scientific thinking.
Ill - THE ETHICS OF DR D.E. CAMERON EXPERIMENT
A) BY TO DAY STANDARDS:
Dr Cameron would have had to submit to the following
procedure before being allowed to carry out his
1 ) Submission of the project to the hospital research
There is a good chance that Dr Cameron project would
have been stopped at this level because of poor
methodology and muddled theoretical basis.
2 ) Evaluation by the Hospital Ethics Committee:
Three principles would be taken into consideration
before granting approval to the project.
a ) Voluntariness :
The committee would have to be assured that the patients
participating in the project would be doing it on a
completely voluntary basis without any form of coercion.
The ethics committee would also have to be assured that
the patient could withdraw from the project at any time.
b ) Informed consent;
The ethics committee would have to be assured that the
patient participating in Dr Cameron's experiment gives a
written informed consent to his participation after the
procedure and the rationale of the experiment were
clearly explained to him Vith all the risks and benefits
c ) Benefit to the patient:
With this type of experiment the ethics committee would
have to be satisfied that the patient could derive a
substantial and direct therapeutic benefit after all
other non intrusive methods had failed. I believe that
under present conditions Dr Cameron would have had a
great deal of difficulties dotay in obtaining approval
from a Hospital Ethics Committee to carry out his work
because of its intrusiveness and the present
availability of a range of new therapeutic techniques.
B) BY THE STANDARDS OF THE FIFTIES:
In my opinion it would be a mistake to believe that
ethical considerations in human experimentation were not
present at the time. However in this period when
medical paternalism was still prevailing the ethics of
an experimental procedure were very much left to the
judgement and the conscience of the researcher and his
associates. No formal procedures were in force.
In 1865, Claude Bernard * wrote on human
"Experiments, then, may be performed on
man, but within uhat limits? It is our
duty and our right to perform an
experiment on man whenever it can save
his life, cure him or gain him some
personal benefit . The principle of
medical and' surgical morality,
therefore , consists in never performing
on man an experiment 'jhich might be
harmful to him to any extent, even
though the result might be highly
advantageous to science, i.e., to the
health of others. But performing
experiments and operations exclusively
from the point of vie'j) of the patient 's
O'jn advantage does not prevent their
turning out profitably to science...
For ve must not deceive ourselves ,
morals do not forbid making experiments
on one's neighbor or on one’s self.
Christian morals forbid only one thing,
doing ill to one's neighbor. So, among
the experiments that may be tried on
man, those that can only harm are
forbidden , those that are innocent are
permissible , and those that may do good
are obligatory" .
* Claude Bernard, An Introduction to the Study of
Experimental Medicine (1865). Trans, by Henry C. Green (New
York: Dover Publications, 1957).
This in my opinion were the prevailing ethical
considerations at the time when Dr Cameron carried out
his work and I believe that he adhered to it because he
was convinced that those chronic psychoneurotics who had
not been helped so far could gain from submitting to
psychic driving. There is no doubt in my mind after
reviewing carefully Dr Cameron's papers on the subject
that therapeutic consideration were paramount in his
motives although I personaly disagree and disagreed then
with the intrusiveness and lack of scientific rigor of
The Government of Canada funded Dr Cameron's work through
the Dominion-Provincial Mental Health grants which I believe
were administered at the time by the Mental Health Division
in the Department of National Health and Welfare.
There is no doubts that the scientific standards of the peer
review committee set up by the Mental Health Division were
not as rigorous as today's Medical Research Council.
However Canadian Psychiatry was very much at that time in
its infancy, the Allan Memorial Institute was very much its
Mecca and to some extent Dr D.E. Cameron was its prophet.
In my opinion in spite of all the media noise there is no
evidence that psychic driving did any irreparable harm to
patients who voluntary submitted to it. The Canadian
Government should not bare any moral responsability for
supporting a project that was essentially therapeutic in its
IV ~ THE ROLE AND THE RESPONSABILITIES
OF THE GOVERNMENT OF CANADA
Frederic Grunberg, m.d., F.R.C.P. (C)
Professor, Dept of Psychiatry
University of Montreal
1. - D. EWEN CAMERON - Psychic Driving. American Journal of
Psychiatry, 112 (7), 1956
2. - D. EWEN CAMERON - Psychic Driving: Dynamic Implant.
Psychiatric Quart 31: 703-712, 1957
3. - D. EWEN CAMERON & ROBERT B. MALMO - Effect of repeated
verbal stimulation upon a f lexer-extenser relationship.
Canadian Psychiatric Assoc. Journal, Vol. 3, NO 2 ,
4. - D. EWEN CAMERON, LEONARD LEVY, L. RUBENSTEIN & R.B.
MALMO - Repetition of verbal signals: behavioural and
physiological changes. American Journal of Psychiatry,
115 (11), 1959
5. - D. EWEN CAMERON, LEONARD LEVY & LEONARD RUBENSTEIN -
Effects of repetition of verbal signals upon the
behaviour of chronic psychoneurotic patients. J. Ment.
Sci, 106, no 443, April 1960
6. - Proceedings - The Third World Congress of Psychiatry,
Montreal, Canada - 4/10 June 1961, University of
Toronto Press, McGill, University Press
7. - D. EWEN CAMERON, LEONARD LEVY, THOMAS BAN & LEONARD
RUBENSTEIN - Repetition of verbal signals in therapy:
in current psychiatric therapies. Ed. J. Masserman,
Greene & Stratton, New York, London 1961
8. - D. EWEN CAMERON, LEONARD LEVY, THOMAS BAN & LEONARD
RUBENSTEIN - A further report on the effects of
repetition of verbal signals upon human behaviour.
Canadian Psychiatric Association Journal, Vol. 6, no 4,
9. - D. EWEN CAMERON, LEONARD LEVY, THOMAS BAN & LEONARD
RUBENSTEIN - Comprehensive Psychiatry. Official
Journal of the American Psychopathological Association,
Vol. 5, No 1, Fevruary 1964
10. - L. LEVY, D.E. CAMERON, T. BAN & L. RUBENSTEIN - The
effects of long-term repetition of verbal signals.
Canadian Psychiatric Association Journal, Vol. 10, no
4, August 1965
NOM: GRUNBERG, Frederic Maril et pere de deux enfants
Adresse: 4065 C8te des Neiges, app. 6, Montreal, Quebec H3H 1W7
Telephone: 937-6926 (residence)
253-8200 poste 219 (bureau)
Titre: professeur, depatesrsnt de psychiatrie
Faculty de mldecme , Universite de Montreal
coordonnateur du Service de 1 ' enseignement universitaire
HSpital Louis-H. Lafontaine
Date de naissance: 21 avril 1927 Nationality: canadienne
Lieu de naissance: Alexandrie, Egypte
Lycee franqais d'A-
Lycle franqais d*A-
(2e partie, phi
Institutions Annie Djpldmes Discipline
Universite de Mont- 1946 PCB
Universitl de Mont- 1952 Doctora t
chimiques et bio-
Universitl de Lon- 1956 DPM
dres, Institute of
Diploma in psy-
FORMATION HOSPITALIERE :
M.D. , D.P.M.
M.D. , F.R.C.P.
M.D. , F.R.C.P.
M.D. , D.P.M.
LICENCES, CERTIFICATE , FELLOWSHIPS :
1956 London University: Academic Post Graduate Diploma in
1957 College Royal des Medecins et Chirurgiens du Canada,
Certificat - psychiatrie
1958 Licence du Conseil Medical du Canada
1958 Licence du College des Medecins et Chirurgiens de la
1961 Licence du College des Medecins et Chirurgiens de l'Al-
1970 Licence du departement de 1' Education de l'Etat de
New York (medecine)
1974 Fellowship du College Royal des Mldecins et Chirurgiens
1976 Licence de la Corporation Professionnelle des Medecins
• • •
LICENCES , CERTIFICATS, FELLOWSHIPS (suite):
1 1977 Certificat ae specialite en psychiatrie, Corporation
Prof essionnelle des Medecins Specialistes du Quebec
1954 Prix de th£se "Montpellier Medical"
Laureat de la Faculte de Medecine de Montpellier
1968 Award of Honor - Letchworth Village Chapter, New York
State Association of Retarded Children Inc.
1973 Meritorious Service Award, New York State Dept of
1973 Meritorious Service Award, New York State United
Institution ou organisms
1956 1 1958
Reginal General Hospital, Munroe
1958 a 1960
Swift Current Mental Health Cli-
1960 a 1962
Yorkton Mental Health Clinic,
1962 a 1964
Sask. Hospital Weyburn
1964 a 1966
Sask. Dept of Public Health
1966 a 1967
Sask. Dept of Public Health,
Psych. Serv. Branch
11967 a 1973
New York Dept of Mental Hygiene,
Albany, New York
Avril 197 3
Albany Medical College, Albany,
Chef de service
1976 a 1981
Universite de Montreal,
Departement de psychiatrie ,
Faculte de medecine.
1981 a date
Hdpital Louis-H. Lafontaine
Service de l'enseigne
Universite de Montreal,
Departement de psychiatrie,
Faculte de medecine.
. . ./4
SOCIETES SAVANTES ET COMITES:
1957 Association des Medecins de Langue
Franqaise du Canada
1958 Association Medicale du Canada
1958 Association des Psychiatres du
1958 College des Medecins et Chirurgiens
de la Saskatchewan
1961 College des Medecins et Chirurgiens
de 1* Alberta
1963 College Royal des Medecins et
Chirurgiens du Canada
1964 Gouvernement du Canada, Ottawa
Ministere de la Sante et du
Comite Consultatif de 1* Assurance
1964 Advisory Council to the College
of Medecine - University of
1965 Gouvernement du Canada
Ministere de la Sante et du Bien-
Comite technique ad hoc sur le
fond des ressources de la Sante
1965 Gouvernement de la Saskatchewan
Comite ad hoc sur 1' education
1966 Association des Psychiatres du
1967 State of New York Department
of Mental Hygiene
Committee on the recodification
of the Mental Hygiene Law
1968 Letchworth Village Chapter, New
Association for Retarded Children,
1972 College Royal des Medecins et
Chirurgiens du Canada
1972 Royal College of Psychiatrists
Membre du Comite de $
cialit£ en psychiatrii
Membre du Conseil d'a
Award of Honor
. . ./5
SOCIETES SAVANTES ET COMITES:
State of New York, Dept of Mental
State of New York United Cerebral
1973 American Academy of Psychiatry S
College Royal des Medecins et Chi-
rurgiens du Canada
Association du Quebec pour les
1982 American Psych. Association
1984 Canadian Psychiatric Assoc iaion
Membre du jury franqais
aux examens de sp^cialite
Membre Associ£ Stranger
Membre du Conseil d' adminis-
Les correlations psychosomatiques en pnysio-pathologie generale
(These - Faculte de medecine de Montpellier - Decembre 1952)
PRIX DE THESE - MONTPELLIER MEDICALE 1954.
C. GROS, B. VLAHOVITCH, F. GRUNBERG
L'Hemispherectomie dans 1 'Hemiphlegie infantile
(La semaine des hopitaux, annales de chirurgie) 29e ann£e,
no 2 - 18 fevrier 1953.
C. GROS, J. CADILHAC , B. VLAHOVITCH, F. GRUNBERG
La sympathectomie pre-ganglionnaire dans les syndromes dou-
loureux post-traumatiqu« du membre superieur
(Montpellier Chirurgicale I, 1-1952 pp. 55-59)
F. GRUNBERG, D.A. POND
Conduct Disorders in epileptic children
. . ./6
(J. of Neurology, Neurosurgery and Psychiatry, 1957 , 20 , 65 .)
F. GRUNBERG, T.F. WARD
Geriatric patients in a general hospital psychiatric unit
(Canad Med Ass J 81 360-4, 1 septembre 1959)
A community mental health clinic
(Canad Nurse 56 209.13, March 1960)
HANLEY, F.W. , GRUNBERG, F.
Reflections on the doctor-patient relationship
(Canad Med Ass J 86 1002-4, 2 June 1962)
XELM, H., GRUNBERG, F. , HALL, R.W.
A reexamination of the Hof f er-Ormond diagnostic test
(Int J Neuropsych 1:307, 12 Aug 1965)
LAFAVE, H.G., HERJANIC, H., GRUNBERG, F.
One year follow-up of 67 chronic psychiatric patients
(Canad Psych Ass J 11: 205-11, June 1966)
LAFAVE, H.G., STEWARD, A.P., GRUNBERG, F. , et al.
The Weyburn experience: reducing intake as a factor in
phasing out a large mental hospital
(Compr psychiat 8: 239-48, Aug 1967)
CASSELL, W.A., GRUNBERG, F. , FRASER, H.N.
The discharged chronic patient's utilization of health
resources: a preliminary report
(Canad Psych Ass J 13:23.9, Feb 1968)
STEWART, A., LAFAVE, H.G., GRUNBERG, F. , et al.
Problems in phasing out a large public psychiatric hospital
(Amer J Psychiat 125: 82-3, 1968)
. . ./7
PUBLICATIONS (SUITE) :
CASSELL, W.A. , SMITH, C.M., GRUN3ERG , F., et al.
Comparing costs of Hospital and Community Care
(Hosp £ Com Psychiat 23-7, 1972)
Who Lives and Dies?
(The New York Times, Op Ed Page, April 22, 1974)
GP.UN3ERG , F. , LAFAVE , K .
La fin de l'asile
(Information psychiatrique , vol. 50, no 5, mai 1974)
Les grandes contestations juridiques de 1 ' antipsychiatrie
(Union Medicale du Canada, Tome 105, 935-941, juin 1976)
F. GRUNBERG, BURTON I. KLINGER AND BARBARA GRUMET
Homicide and Deinstitutionalization of the Mentally 111
(Am J Psychiatry 134:6, June 1977)
J. FUENTES BIGGI, U. GOETZL, F. GRUNBERG
Psicosis toxica de larga duraction por phencyclidina
(Archivos de Neurobiol, 40, 2 (117-122), 1977.
F. GRUNBERG, UGO GOETZL, BERNARD BERKOWITZ
Lithium Carbonate, in the Management of Hyperactive
Aggressive Behavior of the Mentally Retarded
Comprehensive psychiatry Nov. /Dec. 1977, vol. 18
F. GRUNBERG, BURTON, I. KLINGER, BARBARA R. GRUMET
Homicide and community-based psychiatry. Journal of Nervous
and Mental Disease, 1978, vcl. 166, no 12
III - LIVRES :
PSYCHIATRY - A concise textbook for primary care practice
Ed. Alan M. Kraft, m.d. - Arco Publishing Co. New York 1977
- SITUATIONAL STRESS, UGO GOETZL and FREDERIC GRUNBERG
. . ./8
III - LIVRES (suite) :
- PERSONALITY DISORDERS, FREDERIC GRUNBERG, M.D.
- MENTAL RETARDATION, FREDERIC GRUNBERG, M.D.
MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES - IX
Ed. Joseph Wortis, m.d. Brunner/Mazel Publishers New York,
- WILLOWBROOK: A VIEW FROM THE TOP, FREDERIC GRUNBERG, M.D.
PSYCHIATRIE CLINIQUE: APPROCHE CONTEMPORAINE
Pierre Lalonde et Frederic Grunberg , GaStan Morin, editeur,
IV - COMMUNICATIONS:
Lafon, R. , Gros, B. , LaBauge , R., Paleirac, R. , Grunberg, F.
(Soc. d'electro-radiologie Medicale du Littoral Mediterraneen,
Nice. 26-27: 1: 1952)
Euziere, G., Gros, C., La Bauge , R. , Cadihlac, J., Grunberg, F.,
Les formes psychiatriques des tumeurs cerebrales
(Soc. Sciences Medicales et Biologiques de Montpellier)
Stance du 14 mars 1952
Lafon, R. , Gros, C., Minvielle, J., Billet, B., Grunberg, F.,
Vlahovitch, B .
Eosinophilie sanguine et traitement psychiatrique
(Soc. Sciences Medicales et Biologiques de Montpellier)
Seance du 25 avril 1952
Vidal, J., Lafon, R. , LaBauge, R. , Minvielle, J., Barjon, P.,
Deux cas d' intoxication aiguS volontaire par compose amphetamini
(Soc. Sciences Medicales et Biologiques de Montpellier)
Stance du 3 mai 1952
. . ./9
IV - COMMUNICATIONS (suite) :
Gros, C. , Lafon, R. , LaBauge, R. , Cadilhac, J., Minvielle, J. ,
Recidive de meningiome temporo-occipital gauche d' expression
(Soc. Sciences Medicales et Biologiques de Montpellier)
Seance du 3 mai 1952
Gros, C., Cazaban, R., Cadihlac, J., Vla'novitch, B. , Grunberg, F.
Ramollissement calcarinien chez un syphilitique . Etude clinique
(Soc. Sciences Medicales et Biologiques de Montpellier)
Seance du 27 juin 1952
Grunberg, F. , LaFave, H., et al.
Reducing the population of a Mental Hospital
Communication au Congres Annuel de 1 'Association des Psychiatres
du Canada, Vancouvert, juin 1964
Financial arrangements as they affect the distribution of
Mental Health Services
Communication a la Conference Nationale des Services de la
Ottawa, 7 janvier 1966
Grunberg , F.
Psychiatry and anti-psychiatry
Grand Rounds, dept of psychiatry, Albany Medical College,
Reform of the Mental Health System Through Court Litigations:
An American Experiment
(Communication au Congres Annuel de 1 'Association des Psychiatres
du Canada, Ottawa, septembre 1974)
Legal Activism and Psychiatry
Grand Rounds at Allen Memorial Institute, McGill University,
10 avril 1974
. . ./10
IV - COMMUNICATIONS (suite) ;
Grunberg , F .
Homicide and Mental Illness
Grand Rounds, Dept of Psychiatry, Albany Medical College,
28 septembre 1976
Grunberg, F. , Klinger, 5., Grume t , S.
Homicide and the Deinstitutionalization of the Mentally 111
Communication a l'assemblee annuelle de 1* American
Academy of Psychiatry and Law, San Francisco, 2 5 octobre 19'
Grunberg , F.
Ethical Considerations on the Tarasoff Decision: Should
Therapists Warn the Potential Victims of their Patients?
Symposium on Ethics in Medicine, Albany Medical College,
January 13-15, 1976
Le patient qui refuse de se soumettre a un examen psychiatric
Communication au Congres Annuel de 1' Association des Psychk
du Quebec, Trois-Rivieres , 7 juin 1979.
. . . annexe
le 9 septembre 1980.
Revise le 19 mars 1982.
- 11 -
PUBLICATIONS ET COMMUNICATIONS:
Grunberg, F. L'angoisse et l'insomnie. Communication
presentee au Symposium de 1 'Association des pharmaciens
du Quebec, Quebec, 11 octobre 1981.
Grunberg, F. Le psychiatre dans les ann§es 80. Communication
presentee dans le cadre du centenaire du centre hospitalier
Douglas, Montreal, 25-26 novembre 1981.
Grunberg, F. Les diffSrentes ecoles de pens§e psychia-
trique. Presentee aux membres du dSpartement de m^decine
g£n6rale, hopital Louis-H. Lafontaine, 14 janvier 1982.
Grunberg, F. Pourquoi les femmes sont-elles tenement
plus d#prim§es que les hommes? Presentee au personnel
medical et para-medical de 1' hopital Louis-H. Lafontaine,
10 fevrier 1982.
Grunberg, F. et coll. Le suicide "Gu§rir le suicide?"
Presentee dans le cadre d'Actuelles a la radio CBF-FM,
29 janvier 1982
Grunberg, F. Aspects pratiques du traitement des depres-
sions en pr£sentant 1' usage des divers medicaments anti-
depresseurs et les autres modalites de traitement biologique,
tel que 1' electrochoc . II a aussi examine les di verses in-
terventions d'orcre psychologique et sociale. Universite
de Montreal, Faculte de 1' education permanente - Les Belles
Soirees" 10 fevrier 1982.
Grunberg, F. Perspective on the care of the longer-term
mentally ill an overview statement. Association Canadienne
pour la Sante Mentale, Toronto, 24-26 fevrier 1982.
Grunberg, F. Le DSM III... ajoute-t-il a la precision du diagnos-
tic Clinique. Colloque de mise 3 jour sur les nouveaux
moyens diagnostiques en psychiatrie. Association des
Psychiatres du Quebec, 26 mars 1982.
Demontigny, C., Grunberg, F., Mayer, A., Desch3nes, J.-P.
Lithium Induces Rapid Relief of Depression in Tricyclic An-
tidepressant Drug Non-Responders. Brit. J. Psychiat 138,
Grunberg, F., Moamaf, N. Desmarais, G., Gagne, E. Examen
psychiatrique sous ordonnance de cour 3 propos des patients qui
refusent de se soumettre 3 un examen psychiatrique. Revue
Canadienne de psychiatrie. Accepte pour publications 09-81
- 7 -
COMMUNICATIONS LORS DE CONGRF.S , SYMPOSIUMS, CONFK.nF.NCES , etc.
CondultzA dz manipulation
2. - CondultzA deilrantzA
3. - Introduction aux claAAlflca-
Introduction aux claAAlflcatloi
dzA troublcA majcurA
I moderatzur dc La journlz
du A ympoAlum )
4. - "SocloLogij of PAychlatrlc
5. - Prf diction dt La dangzroAlte
tn pA ye Itla trie
6. - Homicide zt pAiJchlatrlz
1.- Concept dz La pAiJchlatrlz mo-
dzrnz, L volution hlAtorlquz,
approchc actuzllz , milieu
dz travail commz InA trumznt
dz rladaptatlon, aza zffztA
be.nl flquzA .
PI flexion Aur la prediction
dz la dangzroAlte zn
9 .- Violence et pAijchiatrle
(congrAs, Association, etc.)
InAtltut Philippe Plnzt dz M tl
InAtltut Philippe Plnzt dz H tl
SympoAlum Aur Iza pA ychoAZA
OrganlAl par I'A.P.Q. zn colla
* boratlon avzc Iza departzmzntA
dz pAiJchlatrlz dzA llnlv.
Laval, HcGllt, Montreal zt
SaAkatchzuian Health, (I nlvzrAltij
llosp. , SaAkatoon
HOpltal Chznzvlzr d Cretzll,
HGpltal dz la Co tomblirz ,
Montpellier , France
CongrzA - Aaa. dzA MedzclnA
du Travail du Quebec
Joume.z Aur Iz AtrzAA, I'alcool
zt la maladlz pAijchlatrlquz
cn milieu dz travail
HOpltal Hotrz-Vamz , Montreal
Ildtel-Pieu de LIvIa , Quebec
Reunion men Aue//.e cfeA
c /i ^ a / A c A *1 u Q«a & l> v c.
- 7 -
l 91 S
10 - 79
(a) (I caract&re
sc lent if Ique
(b) A caractAre
de vulgar I snt Ion
un X si an
ret. rnuve ilans
.«.« ns rnNCRES. SYMPOSIUMS, CONKERRNCRS, etc.
cnuu/io u(i uiieoec
COMHUN ICAT1QM 3 L OUS nr. CO NCUR S, S Y HfOS I U MS , CON KFB RHCF- S . etc.
12 . -
Animate.uK - jouKnle d 1 auto-
€ valuation psychiatKique
FKSAP- 1 V
The futuKe o& the Mental llosp.
Le patient qui Ke&use de
se soumettKe & uh examen
(congr&s, Association, etc.)
APQ - JouKnfe d’ auto- Ivaluatioi
[Association des PsychiatKes
HGpital Douglas . MontKlal
CongKls annuel de l' Associatio
des PsychiatKes du Quebec,
Common 1 cat Ion
(a) A carnct^rc
aclent If l«|iie
(b) A caractAre
de vulgarism Jon
mi X al ne
ret rou ve Jana
Grunberg, F. Pourquoi les femmes sont-elles tenement
plus deprimees que les hommes? Presentee au personnel
de l'hopital Louis-H. Lafontaine dans le cadre du
programme d ’ enseignement multidisciplinaire , 10 fevrier
Grunberg, F. Classification des maladies mentales.
Presentee aux membres du departement de medecine
generale, hopital Louis-H. Lafontaine, 3 juin 1982.
Grunberg, F. Chomage . Nouvelles TVA, Tele-metropole , 9
Grunberg, F. "La crise de la quarantaine" . La Vie
Quotidienne, Radio-Canada, 30 septembre 1982
Grunberg, F. Conference presentee a Ottawa au Ottawa
General Hospital. "A new approach to the problem of
suicide". 26 janvier 1983
Grunberg, F. Participation au debat sur la depression a
1' emission Forum, Tele-metropole, 5 mars 1983
Grunberg, F. Psychiatry grand rounds " The judiciary
dimension in the hospitalization of psychiatric patients
in Montreal", Centre hospitalier de St-Mary, 17 mars 1983
Grunberg, F. Participation au debat sur les droits des
malades mentaux a 1’ emission Forum, Tele-metropole, 19
Grunberg, F. Participation au symposium international
sur la schizophrenie et sa famille, 22 et 23 septembre
Grunberg, F. Preside une seance lors du symposium
"Neurotransmetteurs Cerebraux et Psychiatrie" organise a
1' intention des psychiatres cliniciens du Canada, Quebec,
les 22 et 23 octobre 1983
Grunberg, F. "The chronic mental patients: is there a
future for them?" conference presentee a "Association of
relatives and friends of the mentally and emotionally ill
Montreal Inc", Montreal, le 2 4 octobre 1983
- Grunberg, F. Participation a une conference de formation
medicale continue: Violence - prediction et implications
legales, Centre hospitalier Douglas, le 8 decembre 1983
- Grunberg, F. Symposium: "Benzodiazepine Therapy Today",
Four Seasons Hotel, Toronto, Ont. - "Benzodiazepine Side
Effects (Rebound Anxiety and Insomnia, Accumulation,
Amnesia), 16 avril 1984
- Grunberg, F. Dans le cadre d'une journee d ' inf ormation
"Les patients sous ordonnance du Lieutenant-gouverneur :
aspects cliniques et legaux" il a presente: Reflexion
d'un psychiatre siegeant a la Commission d'examen, Hotel
Reine-Elizabeth, 19 octobre 1984
- Grunberg, F. "Legislation et le reseau des services
psychiatriques" Cours en sante mentale. Programme de la
Maitrise en Sante communautaire du departement de
medecine sociale et preventive, Universite de Montreal,
30 janvier 1985
- Grunberg, F. "La judiciarisation des maladies mentales"
presentee au Congres de 1 ' Association des hopitaux du
Quebec les 14 et 15 mars 1985
- Grunberg, F. Participation au colloque sur "Les aspects
medico-legaux dans la pratique psychiatrique courante",
Le titre de sa conference: "Logique legale versus
logique psychiatrique". Colloque organise de concert
avec l'Institut Philippe Pinel et l'hopital Louis-H.
Lafontaine, 26 et 27 avril 1985
- Grunberg, F. Participation au congres de l'A.P.Q. II a
presente "Le suicide et la maladie mentale", les 14 et 15
le 5 juillet 1985
UNIVERSITY OF SASKATCHEWAN
Ref File No
January 8, 1986
Mr. George T.H. Cooper
P.0. Box 730
1673 Bedford Row
Hal i fax ^ N.S.
Dear Mr. Cooper:
This letter is in response to telephone discussions I had with
jou in late November , the substance of which was set down in your letter
of November 26, 1985. In this letter you set out the questions you wished
answered regarding the Allan Memorial Institute, and specifically the
practice of its late Head, Dr. Ewen Cameron.
In addressing your questions, I should record certain caveats I
feel must be taken into consider at ion by anyone when reading my opinions
;>en the specific issues being addressed.
In the first place, I did not know Dr. Cameron personally.
Although I met him on one occasion socially I did not have the opportunity
to hear him at scientific meetings or professional gatherings. As a
result, any observations I make are based solely on those papers of Dr.
'a that I was able to obtain.
Secondly, my opinion of Dr. Cameron's research competence is
on a small sample of the total number of papers published during the
se of his career. The sample did include, however, papers relating
his research into "Psychic Driving" and "Depatterning" . It would
»ar that these were two major areas of interest to him during the
latter part of his career.
Finally, my opinions regarding "the directions in which
psychiatric research was heading at the time" , and particularly the status
of medical ethics at the time, are based to seme extent on personal
[experience, but to a larger degree, on my evaluation of the research
papers that were published in the three major national psychiatric
publications, namely, the Journal of the Canadian Psychiatric Association,
the Journal of the American Psychiatric Association, and the Journal of
Mental Science (subsequently to become the British Journal of Psychiatry) .
I chose as my criterion year 1962 as this was the year in which Dr.
[Cameron's paper on "The Depatterning Treatment of Schizophrenia" was
published in "Comprehensive Psychiatry" (April 1962) .
In xny opinion, in order to understand the level of development
of psychiatric theory and practice in the 1960's, one must view it against
the background of developments in medicine as a whole. The tremendous
growth in clinical and basic medical research which occurred following
World War II was stimulated not only by the development of new
technologies, tut also by the wedding of clinical medicine with
biostatistics. Ihis development led to increased rigour in medical
research, which in turn impacted on all areas of medicine, including
Psychiatry. There was, however, a lag in the development of psychiatric
research as was noted in the introduction to Report #42 (1959) of the
Group for the Advancement of Psychiatry. In this report it was stated "in
comparison with other fields, psychiatry does not have the strong research
tradition oriented to systematic emperical investigation of important
problems. At the same time, we do have a great need for immediately
applicable working formulations which offer seme guide to treatment.
These conditions favor quick and often premature closure with plausible
hypotheses provided by respected authorities. In time, it may be easily
forgotten that they are unverified hypotheses and they come to be treated
as established fact. It is however true, in Psychiatry as in other
scientific fields, that authority is no substitute for evidence - ! 7 * (the
underlining is mine) . I think this latter statement is particularly
applicable to the work of Dr. Cameron.
The review of the indexed psychiatric journals of 1962 would
indicate to me a movement towards greater precision in the diagnosis and
classification of psychiatric disorder; greater interest in population
studies of patients with particular disease entities; increasing interest
in the search for physiological correlates of behaviour and increased
interest in the evaluation of treatments. The general thrust represented,
in my mind, a departure from the period that immediately followed World
War II when psychoanalytic and socio-cultural theories of behaviour were
in the forefront of psychiatry and biological psychiatry was relegated to
the background. Unquestionably the introduction of tranquillizers and
subsequently the antidepressants sparked a renewed interest in the
biological basis of behaviour and brought psychiatry and the neurological
sciences closer together. However, the transfer of the research
methodologies of the so-called hard sciences (e.g. Biochemistry,
Neurophysiology, etc.) to psychiatric research was confounded by numerous
difficulties, not the least of which was the lack of generally accepted
classification of mental disorder. Indeed, this inability to agree upon
diagnostic criteri4?f was to present a major obstacle to the generation and
sharing of new information about psychiatric illness. Undoubtedly this
contributed to the lag in the development of psychiatric research.
In reviewing these journals and a number of textbooks of the
day, it was cibvicus that psychiatry in the late 1950 ' s and ' 60's continued
to use treatments which had historical but not scientific legitimacy.
This is amply illustrated in an article in the American Psychiatric
Association Journal of 1962 by an emminent British Psychiatrist who
expounded on the significant contributions to patient care provided by
such treatments as labotany, ccma insulin, amphetamines and barbiturates.
Within a few years, of course, all of these treatments had fallen into
disrepute either because of the lack of evidence of effectiveness or
because the risks attendant upon their use far outweighed what therapeutic
value (if any) was derived frcro their use. Even electroconvulsive
therapy, then in wide use and currently still considered an effective
treatment for a limited number of conditions, was generally accepted even
in the absence of any scientifically valid measure of its effectiveness.
Indeed, Kendel, in a recent publication, indicated that of all the
countless studies involving the use of ECT, only ten met his criteria as
being truly "scientific".
In the late 1950's and early ' 60's psychiatric research as we
know it today, was in its infancy. There were relatively few centers with
established research departments or programs. Althcwgh there wre
increasing numbers of reports on new treatments, the quality of these
studies was distressingly lew. This was particularly true of clinical
trials of new drugs. The Allan Memorial Institute was one of the few
North American Institutions that was committed to the development of both
psychiatric research and psychiatric researchers. It was acknowledged to
be the leading academic psychiatric centre in Canada. It also enjoyed an
enviable reputation in the United States and abroad. Certainly much, if
not most, of the credit for its early reputation belonged to Dr. Ewen
Cameron. Dr. Cameron was recognized by his peers as being one of the
leaders, if not the leader, of Canadian psychiatry. His reputation was
built on his early achievement in organizing psychiatric services in
Brandon, Manitoba during the 1930's, and his development of a teaching and
research program at the Allan Memorial Institute in the 1940 's and 1950 's.
He was able to attract a coterie of bright young psychiatrists, many of
whcm subsequently became heads of academic departments in North America or
were to make their name in fields of teaching or research. Cameron had an
impeccable background. Cameron received his M.B. at the University of
Glasgow and in 1925 received his Diploma in Psychological Medicine from
the University of London. In 1936 he received his M.D. "with distinction"
fron the University of Glasgow. In 1937 he was elected Fellcw of the
American Psychiatric Association. Insofar as his psychiatric training was
concerned, he received his initial training at the University of London in
1925 receiving his DIM, and in 1926 was a Henderson Research Fellcw at the
Fhipps clinic in Baltimore. He also spent seme time at the Burghoelzli
Clinic. This was an internationally renowned psychiatric training centre.
Fran 1929 to 1936 he was the Director of the Provincial Mental Hospital in
Brandon. From 1936 to 1938 he was a Resident Director of Research at
Worcester State Hospital, and from 1938 to 1943 he was Professor of
Neurology and Psychiatry at the Albany Medical College in New York. In
1943 he was appointed Professor and Head of the Department of Psychiatry,
University of McGill. In a biographical sketch written by Dr. Gregory
Zilboorg in the American Psychiatric Association Journal, 1953, it was
noted that by that time he had authored 80 articles and "several books".
A review of his curriculum vitae reveals that he quickly climbed the
academic ladder. His overall position in the profession is attested to by
the fact that he was elected to head three prestigious psychiatric
organizations; the Canadian Psychiatric Association, the American
Psychiatric Association, and the World Psychiatric Association. In short,
whatever his shortcomings as a person, he obviously was a credible figure
It would appear that Cameron had an interest in both Neurology
and Psychiatry. This was not uncommon in those days, as many
psychiatrists had dual training. Although not a psychoanalyst, he, like
many of his contemporaries, borrowed freely from psychoanalytic concepts,
such as the role of the unconscious, intrapsychic conflict, etc. Lite
many of his contemporaries, his theorizing reflected both psychoanalytic
and biological interests. Certainly his work in depatterning and psychic
driving would reflect this orientation. Cameron was not alone in this,
however, as Lawrence KUbie and the renowned Walter Penfield co-operated in
efforts at finding a structural basis for psychoanalytic concepts.
In evaluating Cameron's work in the 1950's and early 1960 's, it
is important to look at the relationship that existed between the patient,
the family and the physician (psychiatrist) . Although I have no hard
evidence to support this, it is my impression that the public acceptance
of physicians at that time was high. Again, it is an impression, not a
fact, that the psychiatrist was held in particular awe by the patient
and/or their family (although not by the public) . I think this
relationship derived from the sense of mystery and ignorance that
surrounded mental disorders. That the psychiatrist, through methods
unfamiliar to them (unlike the general practitioner) could make sense out
of what frequently was an irrational situation, served only to enhance his
position. Frequently the family abdicated its responsibility for
determining what was best for the patient. They were quite happy to
transfer this responsibility to the psychiatrist or the medical
superintendent. It has been my experience that by and large,
psychiatrists honoured this trust and that their treatment of patients was
determined by commitment in what they thought was best for the patient.
Unfortunately , events would indicate that their idea of what was "best for
the patient" was based on inadequate theory and scientific evidence.
Unfortunately, confronted with enormous demands for their services and a
paucity of effective treatments, the psychiatrist, in the 1950 's and early
'60's, frequently resorted to new treatments that had not yet demonstrated
(scientifically) their effectiveness but held out the promise of "cure".
In my opinion, this was quite understandable.
In spite of the advent of tranquillizers, Schizophrenia remained
an enigma to the psychiatrists of the 1950 's and 1960 's. It may explain
why Dr. Cameron, mindful of his leadership goal, would choose to tackle
this difficult and perplexing problem. In reviewing the past experience
with the treatment of schizophrenics, he noted the distressingly high rate
of relapse. He surmised that this was due to one of two causes; either
inadequate initial treatment or lack of appropriate after-care. He
obviously felt that schizophrenics should be given intensive treatment
initially. He believed that schizophrenia was the result of learned
maladaptive thinking. His object, therefore, was to "depattem" the
patient's thought processes through the use of three techniques: 1)
massive electroconvulsive therapy, 2) continuous sleep and 3) maintenance
elecro therapy. None of these techniques was new. Massive ECT had been
used (sparingly) since 1946 and continuous sleep treatment had enjoyed a
vogue seme ten to fifteen years previously. Neither were, at the time of
Cameron's experiments in the 1960 's, generally in use and one might
conclude from this that they were not generally accepted. Maintenance
ECT, however, while not universally accepted, did have a modest
following, but was soon to be replaced by major tranquillizers and
antidepressants. Electroocnvulsive Therapy itself was widely used and
generally accepted as being effective in a variety of psychiatric
disorders. It was generally given three times a week until such time as
there was a significant improvement in the patient's clinical state. On
the whole, it would mean seme 8 to 12 treatments, (not infrequently less
and occasionally more) . The introduction of muscle relaxants in ECT
enabled increasing numbers of patients to receive this treatment, who had
previously been excluded on medical grounds. ECT continues to be used in
psychiatric treatment, albeit for a restricted group of disorders.
In summary then, the treatment techniques used by Cameron in his
depatterning experiments had previously been used in psychiatry. Although
by 1962 I would think that only maintenance ECT still enjoyed any vogue
During the late 1950 's and early '60's great changes took place
in the care of the mentally ill. Simultaneous with the introduction of
new and effective chemotherapy, there was recognition of the possible
harmful effects of long-term hospitalization. This raised the expectation
among psychiatric professionals of finding new and effective methods for-
reducing the length of stay, and indeed, even preventing the admission of
patients suffering from psychiatric disorder. The acquisition of
effective treatment methods had a significant impact on the morale of
people working in mental hospitals. They saw their facility changing from
that of a warehouse to that of an active treatment and rehabilitation
centre. The demand for newer and more effective drugs stimulated a spate
of drug trials. However, clinical trials, using psychiatric patients and
particularly outpatients, were found to be fraught with difficulties. It
was difficult to collect significant number of outpatients to draw
statistically Veil id conclusions. In addition, psychiatric patients were
notoriously non-ccsnpliant, making it difficult to determine whether they
were taking their medication or not. Psychiatric outpatients were also
inclined to drop cut of treatment studies because of lack of motivation,
secondary to the disease process. It was understandable then, that faced
on the one hand with the problems of designing and implementing
scientifically rigorous clinical trials on an outpatient basis, and on the
other hand, with the need to find answers to pressing clinical problems,
many researchers turned to the mental hospitals and psychiatric units for
subjects of clinical research. By using inpatients of large provincial
hospitals the methodological problems of patient numbers, compliance,
attrition rates, were significantly reduced.
Patient advocacy and patient rights were not significant issues
in psychiatric practice in the late 1950's and early 1960 's. Mental
health legislation, while providing the opportunity for the appeal of
commitment procedures, did not incorporate patient advocacy within
Provincial Mental Health Acts. The patient and/or their family were left
to their own devices (perhaps with the assistance of their lawyer) in
dealing with conflicts between themselves and hospital authorities. This
placed many families in a difficult situation, as they were frequently
totally dependent upon the institution for care of their family member.
For this reason, "consent for treatment", either by or on behalf of the
patient could be open to question as to whether or not it was truly freely
Dr. Cameron's research activities would seem, in my opinion, to
reflect the standards of his day. While his research methodology as
presented in his papers was seriously flawed, it was not significantly
worse than that of others appearing in the literature at that time.
Psychiatric reports of the time frequently were lacking in specific and
precise diagnostic criteria and standardized outcome measures. As an
illustration of this point, I refer you back to Kendel's evaluation of
research done an ECT.
The topic of Cameron's research (e.g. schizophrenia) was an
appropriate one as it represented one of the major clinical problems
facing psychiatrists of the day. His belief that prompt and adequate
tratment, and a well monitored after-care program as essential ingredients]
to reducing the degree of disability in schizophrenics would appear
reasonable. His method of achieving this, however, I think is seriously
open to question because of the use of two techniques which carried a not
inconsiderable risk and which hitherto had not been established as being
In commenting on the ethics of psychiatric research, past and
current, one must first of all review developments in all research
involving use of human subjects. Certainly the revelations of the abuse
of human subjects in so-called medical research carried out in Germany and
Japan during the second world war sensitized the medical and scientific
communities to the need for a universal code of ethics. The evolution of
this code is described in the Medical Research Council of Canada Report #6
(1978), "Ethics in Human Experimentation". The first set of guidelines
would appear to have been the Nuremkurg Declaration, which of course arose
out of the proceedings involving war crimes trials in the late *40's.
Subsequent to this, the Declaration of Helsinki (1964 and 1974) was
adopted by the World Medical Association as a set of guidelines governing
human experimentation. Finally, a working group established in 1977 by
the Medical Research Council of Canada proposed guidelines applicable to
research carried on in Canadian institutions by Canadian researchers.
I will not discuss MRC Report in detail as it is readily
available to you. I would point cut only that this report established
that the Aina qua non for all research involving human subjects is that it
be scientifically valid. "Without scientific merit, placing human beings
at risk to perform an experiment cannot ethically be justified". The
report goes on to discuss a variety of issues such as "informed consent",
the lose of "captive" subjects, the use of one's own patients in research,
and the ethical responsibilities of the investigator, the institution and
the granting agency. In addition to setting out ethical guidelines the
report also proposes procedures for implementation, such as the
establishment of institutional ethics committees, and the documentation in
grant applications to the Medical Research Council of the fact that
ethical issues have been considered and resolved to the satisfaction of
the investigator and the institutional ethics committee. It is my
opinion, based primarily on my experience in the College of Medicine,
University of Saskatchewan, that these guidelines are adhered to and have
resulted in increased sensitivity to ethical issues related not just to
medical research but to patient care in general. In my opinion, had these
guidelines been in place at the time of Cameron's work in the Allan
Memorial, I have serious doubts as to whether he would have been able to
proceed with his work. Certainly not in the fashion described in his
It is difficult to compare ethical practices of the present with
those in the past. Certainly this is especially true in research. The
major source of information we have about research are the reports
published in scientific journals. Unfortunately, the issue of hew
patients are "recruited" into research programs is rarely addressed.
True, there are some papers, notably those in psychology, where the use of
"volunteers" is specifically stated. But even here one must raise a note
of caution as the use of "volunteers" does not necessarily guarantee that
such issues as informed consent have been satisfactorily addressed, (see
Halushka v the University of Saskatchewan, Dominion Law Report 53 (20,
436-466 (1965) . Because of the above, I feel that I can only make a
general statement about the ethical standards of medical and psychiatric
research. I believe it is now quite clearly recognized that the
responsibility for ensuring the quality (both from scientific and ethical
standpoints) of research involving human beings lies jointly with the
investigator, the institution in which he works, and the granting agency
that supports his research activity. In my opinion, all three could and
would be currently held accountable for research projects that do not meet
the current standards of research practice in Canada. We have arrived at
this point through gradual evoluation as witness the report of the Medical
Research Council's working group. Certainly the case of Halushka v
University of Saskatchewan would indicate that the present ethical
standards were not universally applied in 1964. For this reason I have
seme question as to whether these obligations were as clearly identified
or as clearly acknowledged by researchers, institutions or granting
agencies in the 1950 's and early 1960 's. I think this was particularly
true in psychiatric research which admittedly lacked the tradition of
research in other areas in medicine. This may partially explain the
apparent indifference of Cameron and others, to what are now held to be
essential safeguards of patients' rights.
I hope that this addresses most of the issues identified in your
letter of November 26.
I.M. McDonald, M.D. ,
Dean of Medicine.
April 27, 1982
McOONALD, Ian Maclaren
Department of Psychiatry
8orn May 20, 1928
Employee No. 33885
2. ACADEMIC CREDENTIALS:
M.D., University of Manitoba, 1953, College of Medicine
3. OTHER CREDENTIALS:
F.R.C.P.(C), Royal College of Physicians and Surgeons of Canada,
A. APPOINTMENT(S) AND PROMOTIONS (U OF S):
Assistant Professor of Psychiatry, Without Term, 1958-62, College of
Associate Professor of Psychiatry, Tenured, 1962, College of Medicine
Professor of Psychiatry, Tenured, 1967, College of Medicine
Head, Department of Psychiatry, Tenured, 1971 to present. College of
5. ASSOCIATE MEMBERSHIPS:
Leave, Edinburgh, Scotland, 1967 to 1968
7. HONOURS (MEDALS, FELLOWSHIPS, PRIZES):
Fellow, American Psychiatric Association
Post-Doctoral Fellow, Edinburgh University, 1967 to 1968
PREVIOUS POSITIONS RELEVANT TO U OF S EMPLOYMENT:
Instructor in Psychiatry, University of Colorado, School of Medicine,
1957 to 1958
Resident (Chief), Colorado Psychopathic Hospital, University of
Colorado, 1956 to 1957
Fellow in Neurology, University Hospital, University of Saskatchewan,
McDONALD, Ian Maclaren
April 27, 1982
1955 to 1956
Resident, Monroe Wing, Regina General Hospital, 195 4 * to 1955
Resident, Crease Clinic, Essondale, British Columbia, 1953 to 195*
9. TEACHING RECORD:
MMSI - 2 to 3 mornings per year
Med. II - 30 IB - Lectures (1 hr x 13); Tutor In small groups (2 hrs x
Med II - 350A - 2 hr seminar
Med III A IV - 3 hrs/week (1 student for each 8-week period)
Med V - JURSI Seminars, Supervision of JURSI Ward Responsibilities
and Outpatient Consultations
Supervision of Inpatient and Outpatient Interviews and Treatment
Home Care Conferences:
- Involves meeting with Home Care Nurses for 1 1/2 hrs every 3 months
to discuss caseload (also on p.r.n. basis)
10. THESES SUPERVISED:
11. BOOKS, CHAPTERS IN BOOKS, EXPOSITORY ANO REVIEW ARTICLES:
12. PAPERS IN REFEREED JOURNALS:
I.M. McDonald, 1971. Diagnostic Significance of Physical Signs Produced
Ouring E.C.T. Canadian Medical Association Journal , 10k , 311 —3 12.
I.M. McDonald, 1970. Psychiatry and the Law. Laval Medical Journal ,
D.G. McKerracher, C.M. Smith, F.E. Coburn and I.M. McDonald, 1966.
General Practice Psychiatry. College of General Practice of Canada
Journal , 12 , 38—% 1 .
0. G. McKerracher, C.M. Smith, F.E. Coburn and I.M. McDonald, 1965.
General Practice Psychiatry. The Lancet , November, 1005-1007.
1. M. McDonald and M. Perkins, 1966. A Controlled Comparison of
Amitriptyline and Electro-Convulsive Therapy in the Treatment of
Depression. American Journal of Psychiatry , 22 , p. 1k27, June.
NcDONALD, Ian Maclaren
April 27, 1982
13. PAPERS IN NON-REFEREED JOURNALS:
14. INVITED PAPERS IN PUBLISHED CONFERENCE PROCEEDINGS AND ABSTRACTS:
15. CONTRIBUTED PAPERS IN PUBLISHED CONFERENCE PROCEEDINGS AND ABSTRACTS:
16. TECHNICAL REPORTS RELEVANT TO ACAOEHIC FIELD:
17. BOOK REVIEWS:
18. INVITED LECTURES OUTSIDE U OF S AND INVITED CONFERENCE PRESENTATIONS:
I.M. McDonald, 1979. Community Psychiatry. November 25, Yellowknife,
North West Territories.
I.M. McDonald, 1978. Confidentiality In Psychiatry. Canadian
Psychiatric Association, Halifax, Nova Scotia.
I.M. McDonald, 1977. Psychiatry and the Law
I.M. McDonald, 1977. Suicide
I.M. McDonald, 1988. Student Mental Health, University of Calgary,
I.M. McDonald, 1988. The Medical Aspects of Privilege, University of
Calgary, Calgary, Alberta.
19. PRESENTATIONS AT CONFERENCES (Non- Invi ted) :
20. PATENTS GRANTED OR PENDING:
McDONALO, Ian Maclaren
22 . -
April 27, 1982
21. RESEARCH GRANT INFORMATION:
22. ARTISTIC EXHIBITIONS OR PERFORMANCES:
2J . PROFESSIONAL PRACTICE:
Clinical Department Heads in the College of Medicine traditionally have
dual responsibilities both as Heads of Academic Departments and Heads
of Clinical Departments of University Hospital. As such, they are
responsible to two governing Boards; namely those of the University
of Saskatchewan and University Hospital. However, Psychiatry has a
third line of accountab 1 1 i ty and that Is to the Minister of Health.
In that the Clinical Department is designated as a 'facility' under
the Mental Health Act and the Department Head is designated as
Medical Of f leer- In-Charge, he Is by law, accountable to the Minister
of Health to ensure that the regulations and provisions of the Mental
Health Act are carried out in accordance with the law. In Saskatoon
an anomalous situation exists in that the Head of the Department of
Psychiatry at University Hospital Is also Medical Off icer-in-Charge
for the two other designated facilities (the Psychiatric Ward at City
Hospital and for the Regional Psychiatric Centre). In fact, then,
the Head of the Department of Psychiatry Is responsible for the
quality of a 1 1 inpatient care in the Saskatoon catchment area. This
includes the 25^,000 population in the Saskatoon Mental Health Region
as well as those inmates of the Federal and Provincial Correctional
systems who may be treated at the Regional Psychiatric Centre. The
duties of the Medical Of f icer- In-Charge entail the monitoring of all
clinical activities in these centres with particular emphasis on
those involving treatment of involuntary patients. It should be
noted that in this province this function is normally carried out by
a Regional Director in the Psychiatric Services Branch. However, In
the Saskatoon catchment area this function of the Regional Director
is carried out by the Head of the Department of Psychiatry at
The Head of the Department of Psychiatry is responsible for the
provision of inpatient, outpatient, day c are, home care activities;
as well as the provision of psychological, social work and
occupational activities within this Department and in other
departments of the hospital where psychiatric patients may be
treated. This results In a number of people reporting directly to
the Department Head; namely, the Clinical Director of 5DE, the Head
Nurse of 5DE; Head of Social Work of 5DE; Head of Occupational
Therapy of 5DE; Head of Clinical Psychology; Head of Division of
Child and Youth Psychiatry; Coordinator of Community Adolescent
Program; Head of Home Care; Coordinator of McKerracher Day Care
Rc DONALD, Ian Maclaren
April 27, 1982
Centre; Head of Psychiatric Services In the Student Health Centre and
Head of Forensic Services In the Department of Psychiatry.
As academic Head of Psychiatry, the Department Head is responsible to
the College of Medicine and the University of Saskatchewan for
providing Undergraduate and Graduate Teaching Programs in Psychiatry
in both the Medical School and for the Royal College Residency
Training Program. The Department of Psychiatry is involved In
teaching programs in Regina and Saskatoon. The Undergraduate
Programs in Regina involve final year (JURSI) students. The
Department of Psychiatry Is also responsible for providing Residency
Training for Psychiatric Residents as well as Family Practice
Residents in both Saskatoon and Regina. The Department is also
involved in various outreach programs in providing continuing
education to District Medical Societies, to Refresher Courses, and
for In-Service Programs within University Hospital and other
* hospitals throughout the province.
The Department Head delegates responsibilities for the various
educational programs to the Directors of Undergraduate Education
(Saskatoon and Regina); to the Directors of Graduate Training in
Psychiatry (Saskatoon and Regina); the Coordinator of Residency
Training in Psychiatry for Family Practice (Saskatoon and Regina).
The Department Head is responsible for encouraging and facilitating the
development and carrying out of research activities both at basic and
clinical levels. As such, he has close liaison with the Research
Division of the Psychiatric Services Branch, Department of Health,
which is physically located within the Department of Psychiatry and
whose senior members hold appointments in the academic department.
The Department of Psychiatry is reponsibie for developing innovative
programming in the area of psychiatric care. As such, it must work
in close liaison with the Department of Health. In accordance with
this working relat ionship, the Department Head and various members of
the Department are involved in many government planning committees,
including such areas as the provision of Forensic Services, Child and
Youth programming, Community Care and Hospital Care.
It should be pointed out that the Saskatoon catchment area (Mental
Health Region) is a self-contained catchment area and may not use
mental hospital beds at Saskatchewan Hospital, North Battleford, for
backup. This places a very heavy service burden on the Department of
Psychiatry, being the major inpatient resource; and, an extra burden
on the Department Head in his joint role as Head of the University
Hospital Department and the Medical Off Icer-in-Charge of all three
inpatient units in the City of Saskatoon.
McDONALD, Ian Maclaren
April 27, 1982
?*. CONSULTING WORK UNDERTAKEN:
Consultant to British Columbia Department of Health re Psychiatric
Emergency Services in Victoria, March, l?8l
Consultant to University of B.C. re Organization of Psychiatric Services
in the Department of Psychiatry, Health Sciences Centre Hospital,
September to November, 1981
2 C . DEPARTMENTAL AND COLLEGE COMMITTEES:
Phase II Curriculum Committee, Member, 1?7^ to present
Pharmacy Committee, Chairman
Medical Staff, President
Medical Advisory, Chairman
Discipline Committee, Chairman
Medical Audit Committee, Member
Abortion Committee, Member
Admissions Committee, Member, l?66-67
Sub-Committees on Curriculum Committee and Forward Planning, Member,
Continuing Medical Education, Member, 1562-6^
Library Committee, Member, 1960-62
2f . UN I VERS I T Y COMMITTEES:
Advisory Committee on Student Health, Member
Campus Committee on Alcoholism, Member
Co-ordinating Committee, RPC, Chairman, Julv, l°8l to present
Tenure Appeal Committee, Chairman. Mav-Julv. l?8l
27. PROFESSIONAL AND ASSOCIATION OFFICES AND COMMITTEE ACTIVITY OUTSIDE
Member, Highwav Traffic Safetv Committee, College of Phvsicians and
Surgeons of Saska tchewan
Member, Mental Health Committee, College of Phvsicians and Surgeons of
Member, Review Panel, National Parole Service, Canada
Member, Advisory Committee on Mental Health. Department of National
Health and V/elfare
Secretary, Section on Psychiatry and Federal Agencies, Canadian
Member, Alcoholism Commission of Saskatchewan
Chairman, Alcoholism Commission of Saskatchewan
Member, Provincial Review Board
Member, Criminal Justice Coordinating Committee
Vice-Chairman, Liaison Committee re Establishment of Regional
Psychiatric Centre in Saskatoon (Canadian Penitentiary Service)
Consultant to National Parole Board
Consultant to Canadian Penitentiary Service
Chairman, Examining Board of Registered Psychiatric Nurses Association
Member, Examining Board of Saskatchewan Association of Social V/orkers
Chairman, Sub-Committee on Confidentiality for Canadian Psychiatric
McDONALD, Ian Maclaren
April 27, 19P2
Assoc iat ion
Member, Consultative Group on Mental Health Research, Department of
National Health and Welfare
Member, Canadian Psychiatric Association
Member, Saskatchewan Psychiatric Association
Member, American Psychiatric Association
Member, Canadian Medical Association
Member, Saskatchewan Medical Association
Member, Vanier Institute of the Family
Chairman. Mental Health, Saskatchewan Association. Task Force, 1?P0-8l
y Consultant to Department of Health, re PSB Programmes, 1?Pl
Consultant to the Canadian Association of Mental Retardation. Toronto,
?R. PUBLIC AND COMMUNITY CONTRIBUTIONS:
Community Psychiatry - Central Butte, Humboldt, Rosthern
Lectures at Saskatchewan Hospital, North Battleford
NOT UNIVERSITY RELATED:
Member, Alcohol Commission of Saskatchewan
Chairman, Alcohol Commission of Saskatchewan
Co-Director, International School of Alcohol Studies
Mental Health Committee, Saskatchewan Medical Association
Highway Traffic Safety Committee, Saskatchewan Medical Association
Chairman, Task Force on Mental Health Services in Saskatchewan, Mental
Health Saskatchewan Association, 1980-82
Member, Working Party on Mental Health Services to the Elderly; Mental
— — Consultant to National Institute on Mental Retardation ( New Brunswick),
Bonner Case, February 198 O
Consultant to Minister of Health, Rivett Enauiry, Saskatchewan Hospital.
North Battleford, 1978
McDONALD, Ian Maclaren
Faculty of Medicine
University of Toronto
Office of the Dean
January 9, 1986
Mr. George T.H. Cooper
P.0. Box 730
1673 Bedford Row
Halifax , N.S. B3J 2V1
Re: ALLAN MEMORIAL INSTITUTE
DR. D. EWEN CAMERON
Dear Mr. Cooper:
I am writing to provide my views on those aspects of Dr.
Cameron's controversial treatment methods at the Allan
Memorial Institute (1953-1964) about which you consulted me.
I will begin by outlining the basis on which I have formed my
opinions and then I will address the points we discussed at
our meeting in Toronto on October 31 , 1985 and that are set
out in your letter to me of November 26th.
I have reached my conclusions on the basis of the
1. Review of some of the papers published by Dr. Cameron
and his colleagues in the professional literature;
2. Review of other contemporary professional
publications in the same journals and in the same
a) American Journal of Psychiatry , Vol 112(1956)
b) Canadian Psychiatric Association Journal
Vols 6 (1961) and 10 (1965)
c) Comprehensive Psychiatry , Vol 3 (1962)
d) Journal of Mental Science, Vol 106 (1960)
Cont 'd. . ./2
Medical Sciences Building. Toromo. Ontario. MSS 1A8
Mr. Cooper - Page Two
January 9, 1986
Review of unpublished personal
memoirs of Dr. R.A.
sor as Professor of
and Director of the
4. Personal knowledge. As a medical student at McGill in
the 1950's and an intern at the Royal Victoria
Hospital I had some contact with Dr. Cameron and his
work. This contact became much more extensive in 1961
when, as a resident in Internal Medicine, I worked on
Dr. Cameron's service at the AMI, both with his
patients who were receiving the controversial
treatments ( depatterning , psychic driving,
hallucinogenic drugs, etc) and those receiving the
more convential treatments of the day. Subsequently,
since 1963, I have been a psychiatrist and have come
into contact with many of Dr Cameron's colleagues,
both admirers and critics, and have formed opinions
about the place of his work in the development of
psychiatry. I was a staff psychiatrist at the Allan
Memorial Institute from 1965 through 1970 and,
subsequently, have held senior clinical and academic
positions in this discipline: Psychiatrist-in-Chief,
Ottawa Civic Hospital and professorial staff,
University of Ottawa (1971-74); Director and
Psychiatrist-in-Chief, Clarke Institute of Psychiatry
and Professor and Chairman, Department of Psychiatry,
University of Toronto (1974-80). I am a member of
the Canadian and American Psychiatric Associations, a
Fellow of the American College of Psychiatrists and a
member of a number of other psychiatric and
psychoanalytic societies. Through these activities I
have an informed, albeit personal, perspective on
Dr. Cameron's work during the period in question.
However, I must point out that I have not had an
opportunity to examine any of Dr. Cameron's applications for
research funds or research protocols, and I have not seen any
of his former patients nor reviewed their files since leaving
the Allan Memorial Institute.
Cont 'd. . ./3
Hr. Cooper - Page Three January 9, 1986
I did not know Dr. Cameron socially, my contact being
restricted to the professional relationship I had as a
resident on his service for three months in 1961, during
which time I saw him virtually daily, and occasionally
thereafter when, as the duty resident, I might be called over
from the Royal Victoria Hospital to assist in the medical
aspects of the care of one of his patients.
D. Ewen Cameron's treatments
"Nothing that has thus far transpired is likely to
be more serious than for humanity to learn how to
control the development of personality and how to
master the forces of group dynamics before we have
developed a value system capable of dealing with
such a s ituation . . . As psychiatrists, we are
physicians having an immemorial responsibility for
the well being of our patients ... Our knowledge of
human nature, our techniques for the exploration of
motive and memory, if torn from their framework of
professional integrity and proper concern for the
individual and for the community may, their use
perverted, become the most deadly weapons yet
directed against the dignity and serenity of human
It is ironic that these words, part of his address as
outgoing president of the American Psychiatric Association,
were spoken by the man who is now villified in some
newspapers and magazines and on television as an unscrupulous
scientist, an agent or dupe of the CIA, who conducted
"sordid" experiments on behalf of this agency using unwitting
Canadian psychiatric patients as human guinea pigs.
Cont 1 d. . ./4
Mr. Cooper - Page Four
January 9, 1986
There can be no doubt that, in retrospect, Cameron's
more extreme experimental treatments were misguided and
ineffective, certainly in the long run. Controversial even at
the time, they may have produced short term benefits for some
patients but it is also quite possible that they resulted in
emotional and, perhaps, organic damage to many others. I do
not believe that any of these treatments has survived
anywhere in the world. The treatments in question are
primarily the following:
1. " Depatterning " , a complex series of procedures
designed to eradicate faulty patterns of thought and
behaviour by producing a more primitive mode of
functioning by the brain and mind of intractably ill
psychiatric patients so that they could subsequently
be "repatterned", or reprogramed, to a healthier more
adaptive mode. Depatterning involved the use of
multiple electroshocks repeated frequently and for a
considerable length of time, usually following a
period of prolonged, drug induced sleep.
2. Powerful psychoactive disinhibiting drugs , including
the injection of shortacting barbiturates mixed with
amphetamines or hallucinogenic drugs (eg LSD,
psilocybin) to attempt short cuts to psychodynamic
understanding that would guide the content of
"psychic driving" and advice re life changes for the
3. " Psychic Driving ", recorded messages with
specifically tailored content played to the patient
many thousand times by a variety of electronic means
for the purpose of changing the patient's thought
patterns and attitudes.
4. Prolongued sensory deprivation , in which an attempt
was made to restrict as much as possible all external
neurosensory input so as to assist in the breaking of
undesirable thoughts and behaviours.
Cont 'd. . ./5
Mr. Cooper - Page Five January 9, 1986
None of these procedures was actually discovered by Dr.
Cameron but their combination, and especially depatterning
and psychic driving, were more extensively developed and used
at the AMI than anywhere else in the world. Dr. Cameron and
some of his colleagues reported widely on their use in
presentations to the public and to scientific audiences and
in extensive writings.
Were these responsible treatments or not?
It is not useful, in my view, to evaluate the use of
procedures in the late 1940's, the 1950's and the early
1960's by the application of today's standards. Certainly,
none of these treatments could be used today in a major
teaching hospital and they would not be supported by a
responsible granting agency. The faulty theoretical basis for
their use, the adverse risk-to-benef i t ratio, the poor
evaluation methodology and the absence of provision for
informed consent are among the factors that would militate
against their use.
The pertinent question is "were these procedures
responsible from a scientific and medical point of view in
the context of the times?" This is not easy to answer. There
was no shortage of contemporary critics of the work. Despite
Dr. Cameron's immense personal prestige - he was generally
regarded as the most important psychiatrist in Canada - he
was not successful in having these treatments widely adopted,
in a profession that was rather prone to the premature
adoption of promising treatments. There were many skeptics,
even in his department at McGill. Many psychiatrists in
Canada and abroad considered the treatment methods extreme,
overly risky and/or without proper theoretical foundation.
Nevertheless, it is clear that Dr. Cameron continued to be
honoured throughout the English speaking world; he was asked
to deliver the prestigious Maudsley Lecture in London.
Cont d. . . /6
Mr. Cooper - Page Six
January 9, 1986
He was elected President of the Canadian, American and
World Psychiatric Associations. He attracted a large number
of postgraduate students and visiting scholars from around
the world, sent to him because of the respect in which he and
his training program were held. Therefore, despite the
controversial nature of his treatment techniques, which were
widely reported to both the professional and the general
public. Dr. Cameron continued to receive acclaim as a leader
in Canadian and world psychiatry. Clearly, this could not
have happened if his peers considered his work irresponsible.
It must be remembered also that the treatments were
carried out openly in one of Canada's leading teaching
hospitals with the full knowledge of his psychiatric,
psychological and other medical colleagues. In addition to
receiving funding from the Society for the Investigation of
Human Ecology, now known to have been a conduit for CIA
funds, his work was supported by responsible national
granting agencies. It should also be stressed that the
Society in question was associated with Cornell University
which was and remains a first-rate American institution of
When Dr. Cameron's papers are compared with other
reports of therapeutic trials in the contemporary psychiatric
literature, it is apparent that his work was no less rigorous
than that of most of his peers. By comparison with the
expected of therapeutic trials today, the papers
be more descriptive and less analytical, the
of subjects was not always rigorous or well
the indications for the treatments were not
out, standardized diagnostic procedures were less
outcome criteria were not well specified,
statistical analysis was much less sophisticated and
follow-up information about the long term effects was either
absent or inadequate. However, by the standards of the time,
Dr. Cameron's work was certainly acceptable.
Cont 'd . . ./7
Hr. Cooper - Page Seven
January 9, 1986
Experiment vs. treatment
Over the past several decades policies have evolved
protecting the public against the premature application
new drugs and other therapeutic procedures. In hospitals,
particularly in university teaching hospitals, there are
guidelines and often strict regulations that govern
introduction of new treatments,
and university) and professional
The institutions (hospital
peers share responsibility
with the attending physician for the use of controversial
treatments in particular patients. A recognizable line is
drawn between the application of the range of standard
treatments and the conduct of experimental trials which
require specific protocols and careful evaluation. During the
1960 's the line was much less
faced with a sick patient, and especially one who
to respond to standard treatment, it was much more
physicians, on their own authority, to use
established treatments if they thought they were likely to be
of help. A high proportion of patients were referred to Dr.
Cameron by other physicians, including other psychiatrists,
because their illnesses had not responded to conventioal
treatment administered elsewhere. Many of them, both
psychotic and severely psychoneurotic patients, were severely
disabled, suffering considerably and at risk for suicide. At
a time when other drastic therapeutic measures, now
discarded, were still part of conventional therapy (e.g.
insulin coma treatment, leucotomy and lobotomy). Dr.
Cameron's methods were not regarded as being so extreme as
they appear in retrospect thirty years later.
Therefore, although with hindsight one would now regard
Dr. Cameron's treatments as experimental and requiring
restricted use and the most rigorous scientific evaluation
before general application, at the time they were regarded as
rather heroic, if extreme, attempts to help patients who were
suffering and were not receiving benefits from conventional
treatments. It is my own personal view that a major
motivation for Dr. Cameron (in addition to the advancement of
his own career) was his wish to help his patients.
Cont ' d . . . /8
Mr. Cooper - Page Eight
January 9, 1986
Medical Ethics, 1950's vs 1980's
Fundamental ethical principles governing the practice of
medicine have not changed during the past thirty years,
having been established over the centuries since the
teachings of Hippocrates, Maimonides and many others. The
physician in Cameron's time, as now, was ethically bound to
place the welfare of his patients above all considerations
including personal advantage, research objectives and the
purposes of agencies supporting the research. Further, the
doctrine of primum non nocere (above all do no harm to the
patient) was taught to medical students then as it is now. It
may indeed be argued that Dr. Cameron's treatments
transgressed both of these well accepted ethical precepts.
The problem lies in the complexity of the issues and how
one assesses the relevant factors. Dr. Cameron may well have
been personally persuaded that his innovative though
dangerous work, which brought him considerable acclaim at the
time and notoriety later, was in the best interests of his
patients. That is, his assessment of the benefit-risk
equation may well have been that the application of unproven
and risky treatments was justified because conventional
therapy had little to offer in these cases. This is a stance
often taken today with patients whose lives are in jeopardy
or who are suffering intractable pain; they are offered such
treatments as heart or liver transplants, highly toxic
anti-cancer medication, surgical interruption of pain tracts
in the spinal cord, and so on. Whether, in fact. Dr. Cameron
genuinely believed that he was acting in the best interests
of his patients is now very hard to determine. Opinions
differ on this point, though most of those who came into
personal contact with him believe that he did, and I share
Cont 'd. . ./9
Mr. Cooper - Page Nine
January 9, 1986
Nevertheless, it is a valid criticism of this position
that, as he became more and more convinced that his methods
constituted valuable therapeutic innovations, his criteria
for the selection of patients for these controversial
treatments seemed to broaden. By the time I became personally
involved wit his patients (1961) it was my own view that many
of the schizophrenic patients who were "depatterned " had not
had adequate trials of appropriate phenothiazine medications
that were then available and many of the psychoneurotic
patients who received hallucinogenic drugs and psychic
driving could have been helped by conventional psychotherapy.
Of course, at the time I was very junior in status and quite
inexperienced in psychiatry; nevertheless, even in hindsight
after more than twenty years of practicing and teaching
psychiatry I still hold this view.
The major change that has occurred since the 1950s with
respect to medical ethics has been the operational
formalization of their application in hospitals and in
research involving human subjects. University and hospital
ethics committees are now broadly representative, usually
including not only physicians and other health professionals
but also lawyers, members of the clergy and members of the
general community. These committees now need to be persuaded
that risky, unproven treatments are more likely to help them
to hurt the patients, and that all possible less dangerous
alternatives have been tried first. Ethics committees today
will not approve research involving human subjects that is
not scientifically valid, that is not likely to benefit the
subjects directly or mankind generally. This was quite
different in the 1950s when much less care was taken to
ensure that therapeutic innovations and research involving
humans met these criteria. Much more was left to the
judgement of the attending physician.
Cont 'd. . ./10
Mr. Cooper - Page Ten January 9, 1986
A related change has been the requirement for informed
consent on the part of patients/subjects or, if they are
incapable of giving this consent, on the part of appropriate
next of kin or guardians. Hospital regulations governing both
treatment and research now call for, first, explicit and
detailed communication to patients or families of the
procedures to be carried out, the rationale for their use,
the potential risks and the alternatives available and, then,
their informed written consent. Indeed, many research
granting agencies require proof of this and many scientific
journals call for explicit confirmation of informed consent
before considering applications for research support or
publication of manuscripts.
During the 1950s procedures were much less stringent.
The patient's general consent to treatment, given on
admission to hospital, was often considered adequate to
permit a wide range of therapeutic procedures. Consent to
participate in research, including therapeutic trials, was
also not nearly so rigorous as it is today. It is not
surprising, therefore, that many persons treated by Dr.
Cameron now claim that they were not fully informed about the
treatments they received. The therpeutic climate of the time
was still characterized by the assumption by patients of a
benign paternalism on the part of the attending physician.
This assumption would be all the greater when the physician
was someone of Dr. Cameron's high reputation and impressive
What responsibility did granting agencies have?
This is a difficult question for me to address with
specific reference to Dr. Cameron's work. As I pointed out
above, I have not seen any of his research applications or
protocols and I am not privy to correspondence with granting
agencies or to their files. Therefore I cannot do more than
make some general comments on this point.
Cont ' d
Mr Cooper - Page Eleven
January 9, 1986
types of safeguards to
ethical standards are
procedures, the dedication
reviewers, and the integrity
then and now have relied on three
ensure that scientific, medical and
high: the adequacy of their review
and skill of expert peer
of the applicants for research
agencies must ensure that they
requ 1 re
information about the research proposed
the rationale, the research methods, and the
data analysis); that the proposal is reviewed by
the field from the points of view of relevance,
and scientific validity; and that grantees have
the appropriate professional and scientific qualifications
and reputation. The only difference today is that these
criteria are better operationalized and that informed consent
of subjects is now specifically required.
Of course, granting agencies that rely on fallible
people to establish procedures and conduct peer review of the
proposals received make mistakes. They sometimes support
research that is scientifically unworthy, or of low relevance
to society or ethically flawed. Furthermore, once the
agencies grant financial support they must rely on the
grantee to conduct the research as it was proposed and
approved and according to high scientific and ethical
Obviously once a granting agency becomes aware that the
research is seriously deficient in any of these areas it will
not likely fund further applications. Grantees who
receive renewals of research support are considered by the
agencies as scientifically and ethically worthy.
A further safeguard is in the subsequent publication of
the work. The major medical and scientific journals all have
careful peer review procedures for selecting manuscripts for
publication. Granting agencies usually will not renew grants
or award new ones to investigators who are not able to get
their work published in peer-reviewed journals. That is, a
second group of peers, often in another country, review the
work for scientific merit, relevance and ethical standards.
Cont ' d . . ./12
Mr. Cooper - Page Twelve
January 9, 1986
fact that two groups
agency ' s
journal's peer reviewers, continued to
applications and manuscripts indicates that his professional
peers were satisfied that the scientific, medical and ethical
standards of the day were met.
In summary, it is my opinion that:
1. Dr. Cameron's controversial treatments (depatterning ,
psychic driving, prolonged sleep therapy, prolonged
sensory deprivation and use of hallucinogenic drugs)
were ineffective and, in retrospect, inadvisable.
2. They were, however, medically acceptable in the
context of the times.
3. They were also, in that context, generally regarded
as extreme attempts to help patients who were not
benefitting from more conventional treatments; that
is, they were not generally considered irresponsible.
4. Whether Dr. Cameron's treatments transgressed medical
ethical standards is arguable. He probably was
personally persuaded that his treatments were in the
best interests of the patients in that the possible
benefits and lack of effective alternative treatments
outweighed the risks. This is clearly a matter of
5. The lack of insufficiently informed consent for the
procedures on the part of some of Dr. Cameron's
patients was not unusual in the context of the
practices of the times.
Cont'd. . ./13
Mr. Cooper - Page Thirteen
January 9, 1986
6. Research granting agencies, then as now, depend
heavily on the judgement of peers and the integrity
of the grantee for the maintenance of high
scientific, medical and ethical standards. In
addition to the controversial support by the Society
for the Investigation of Human Ecology, responsible
national granting agencies evaluated Dr. Cameron's
proposals and responsible psychiatric journals
published his manuscripts after they were subjected
to peer review.
Dr. Cameron's professional peers were well aware of
the treatments he carried out and yet they bestowed
upon him acclaim as well as criticism, honours and
high professional offices.
I hope that my opinions will be useful in the
preparation of your report to the Honourable John Crosbie,
Minister of Justice of Canada.
Frederick H. Lowy
Born: January 1, 1933, Grosspeter6dorf , Austria
Canadian Citizenship: December 2, 1950
Married: Wife - Mary Kay O'Neil-Lowy, PhD; 4 children
Address: 338 Inglewood Drive
Toronto Ontario M4T 1J6
Telephone: 482-4063 (home)
1980- Dean, Faculty of Medicine, University of Toronto
1974- Professor, Department of Psychiatry, University of Toronto
1985- Vice-President, Association of Canadian Medical Colleges
1985- Chairman, Council of Ontario Faculties of Medicine
Con6ultant, Ontario Cancer Institute
Consultant, Addiction Research Foundation
Consultant, Mount Sinai Hospital
Consultant, North York General Hospital
Consultant, Princess Margaret Hospital
Sunnybrook Medical Centre
St. Michael's Hospital
Toronto General Hospital
Toronto Western Hospital
Women's College Hospital
Consultant, Wellesley Hospital
Consultant, Clarke Institute of Psychiatry
Member, Board of Trustees, Sunnybrook Medical Centre
Board of Trustees, Ontario Cancer Institute
Board of Trustees, Mount Sinai Hospital
Board of Trustees, Toronto General Hospital
Board of Trustees, Toronto Western Hospital
Board of Trustees, Eye Research Institute of Ontario
1. Elementary schools in Lisbon, Philadelphia, Montreal.
2. Baron Byng High School, Montreal, 1946-50
3. Machon Lemadrichei Chutz Laaretz
(Institute for Youth Leaders from Abroad), Jerusalem,
4. McGill University, Faculty of Arts 1950-52, 1953-55
5. McGill University, Faculty of Medicine, 1955-59
Academic and Professional Qualifications
1955 B.A. (Psychology), McGill University, Montreal
1959 M.D. , C.M., McGill University
1959 Licensee, Medical Council of Canada
1960 Licensee, National Board of Medical Examiners, USA
1965 Certificant in Psychiatry, Royal College of Physicians and Surgeons
of Canada - CRCP (C)
1967 Diplomate, American Board of Psychiatry and Neurology
1970 Graduate, Canadian Institute of Psychoanalysis
1971 Fellow, Royal College of Physicians and Surgeons - FRCP (C)
Professional Post Graduate Education
1959- 60 Rotating internship, Royal Victoria Hospital, Montreal
1960- 61 Junior Assistant Resident in Medicine, Royal Victoria Hospital,
1962-64 Resident in Psychiatry, University of Cincinnati College of
Medicine and related hospitals, Cincinnati, Ohio
1964-65 Chief Resident in Psychiatry, Cincinnati General Hospital
and Veteran's Administration Hospital, Cincinnati, Ohio
1966-70 Training in Psychoanalysis, Canadian Institute of Psychoanalysis,
Previous Appointments - University
1965- 66 Demonstrator, Department of Psychiatry, McGill University
1966- 68 Lecturer, Department of Psychiatry, McGill University
1968-70 Assistant Professor of Psychiatry, McGill University
1971-72 Associate Professor of Psychiatry, University of Ottawa
1973- 74 Professor, Department of Psychiatry, University of Ottawa
1974- 80 Professor and Chairman, Department of Psychiatry, University
Previous Appointments - Hospital
- 3 -
1965-67 Clinical Assistant in Psychiatry, Royal Victoria Hospital, Allan
Memorial Institute, Montreal
1967-69 Assistant Psychiatrist, Royal Victoria Hospital, Montreal
1969-70 Associate Psychiatrist, Royal Victoria Hospital, Montreal
1971-74 Psychiatrlst-in-Chief , Ottawa Civic Hospital
1971-80 Director and Psychiatrist-in-Chief, Clarke Institute of
Professional Editorial Posts
Associate Editor - Canadian Psychiatric Association Journal
Editor - Canadian Psychiatric Association Journal (now Canadian
Journal of Psychiatry)
Editorial Board - Canada's Mental Health
Editor Emeritus, Canadian Journal of Psychiatry
Editorial Board, Montage
Corresponding Editor - The International Journal of Psychiatry
Editorial Board - Psychiatry, Medicine and Primary Care
Editorial Board - Social Psychiatry
Director, Sleep and Dream Laboratory, Allan Memorial Institute, Montreal.
from its organization in May 1967, until December 1970.
Head, Psychotherapy Research Section - Clarke Institute of Psychiatry,
from its organziation in 1978 to 1980.
Major Organizational and Administrative Appointments
President, Student's Council, Baron Byng High School, Montreal 1949
Managing Editor (1953) and Editor (1954) McGill Daily
Student's Executive Council, McGill University (1953-54 and 1958-59)
Editor, CAMSI Journal (Canadian Association of Medical Students and
President, McGill Medical Class of '59'.
Medical (Post graduation)
Member, Development Committee, Royal Victoria Hospital, Montreal, 1968*70.
Secretary, Consortium of Faculty, Department of Psychiatry, McCill
Program Chairman, 7th Annual Convention, Quebec Psychiatric Association
Member, Medical Advisory Committee, Ottawa Civic Hospital, 1971-74.
Secretary, Medical Advisory Committee, Ottawa Civic Hospital, 1973-74.
Member, Executive Committee, Ottawa Civic Hospital, 1973-74.
Chairman, Credentials Committee, Ottawa Civic Hospital, 1973-74.
Member, Task Force on Demonstration Model Grants, Health Research
Committee, Ontario Council of Health, 1972-74
Member, Advisory Board, Ontario Mental Health Foundation, 1972-78
Member, Search Committee for Chairman of Psychiatry, University of Ottawa,
Member, Examining Board (Psychiatry), Royal College of Physicians and
Surgeons of Canada, 1972-77. (Chairman - 1975-77)
Member, Executive Committee and Dean's Senior Advisory Committee, Faculty
of Medicine, University of Toronto (1976-78)
Member, Program Committee, American Psychiatric Association (1976-80)
Nucleus Member, Speciality Committee, Royal College of Physicians and
Surgeons of Canada (1977-81)
Reviewer, Department of Psychiatry, University of British Columbia, 1979
Reviewer, (for Royal College), University of Montreal, 1980
Reviewer, Department of Psychiatry, McMaster University, 1983
Reviewer, Department of Psychiatry, Queen's University, 1984
Consultant, Sultan Qaboos University, Sultanate of Oman, 1984
Member, Council of Ontario Faculties of Medicine (1980-)
Vice-Chairman, Council of Ontario Faculties of Medicine (1983- )
Member, Senior Advisory Group, University of Toronto (1982- )
Member, Executive, Association of Canadian Medical Colleges (1982- )
Member, Board of Regents, American College of Psychoanalysts (1983-85)
Alpha Omega Alpha
Canadian Medical Association
Canadian Psychiatric Association
Ontario Psychiatric Association
Canadian Psychoanalytic Society
International Psycho-Analytical Association
American Psychiatric Association (Fellow)
American College of Psychiatrists (Fellow)
American College of Psychoanalysts (Fellow)
American Psychosomatic Society
Association for Psychophysiological Study of Sleep and Dreams
American Association for the Advancement of Science
International College of Psycosomatic Medicine (Fellow)
Academy of Medicine, Toronto
Society for Psychotherapy Research
Dr. F.R. Eccles Memorial Lecturer, University of Western Ontario February
Fellow, American Psychiatric Association, 1975
Fellow, American College of Psychiatry, 1979
Fellow, American College of Psychoanalysts, 1979
Fellow, International College of Psychosomatic Medicine, 1979
Member, Benjamin Rush Society (USA), 1981
Award of Merit, McGill Society of Toronto, 1984
Major Presentations at Scientific Meetings and Invited Lectures
1964: - (with H.W. Wylie, Jr. and P. Lazaroff): The Death of a Patient
in a Psychotherapy Group. Annual meeting, American Group Psychotherapy
Association, New York, January 1964.
1967: - (with Z.J. Lipowski): The Alm6 and Techniques of Psychiatric
Consultation in Medicine. Annual meeting, Canadian Psychiatric
Association, Quebec, June 15, 1967.
1968: ~ (with R.M. Wintrob and B.K. Dhindsa): Man and his Anxiety. Annual
meeting, Quebec Psychiatric Association, Montreal, May 3, 1968.
1969: - (with R.A.H. Kinch, B.K. Lewis, R.N. MacDonald and C.R. Scriver):
The Teaching of Behaviour, Growth and Development in the Preclinical
Years of Medicine. Annual meeting, Quebec Psychiatric Association,
Quebec, May 22, 1969
1969: - (with R.M. Wintrob, B. Borwick, G. Garmaise and H.O. King):
A Follow-up study of Emergency Psychiatric Patients and Their
Families: Methodological Problems. Annual meeting, Canadian Psychiatric
Association, Toronto, June 11, 1969.
1970: - (with T.K. Kolivakis): Autocastration by a Male Transsexual: Case
Report and Some Notes on the Management of Transsexualism. Annual
meeting, Canadian Psychiatric Association, Winnipeg June 19,
1970: ■ Is Abreaction Always Desirable? The Misuse of an Early Psychoanalystic
Concept. Group without a Name Psychiatric Research Society, Montreal,
October 16, 1970.
- Tetrahydrocannabinol and Sleep. Joint meeting, Montreal Physiological
Society and Medicinal Chemists Division of Chemical Institute
of Canada, Pointe Claire, Ottawa, January 23, 1971
- (with R. Broughton and J. St. Laurent): Significance for Psychiatrists
of Current Sleep and Dream Research. Annual meeting, Quebec Psychiatric
Association, Sherbrooke, Quebec April 22, 1971
- (with B. Humphrey, P. Beck, D.J. Lewis, A. Schwartzman and L. Stephens):
Response to a Medicare Strike in a Psychiatric Hospital. Annual
meeting, Canadian Psychiatric Association, Halifax, June 12, 1971.
1972: - Patients who Somatize, Annual meeting, Ontario Psychiatric
Association, Toronto, January 29, 1972
- Psychoanalytic Dream Theory in the Light of Recent Dream Research,
Ottawa Psychoanalytic Group, March 27, 1972
- Research on Dreams - Some Current Issues. Ottawa Academy of Medicine,
Section on Psychiatry, April 4, 1972
- The Psychology of Sleep - Some Current Issues. First Canadian
International Symposium on Sleep. McGill University, Montreal,
April 14, 1972.
- The Psychiatrist-Physician Relationship in General Hospitals: Present
and Future. Annual meeting, Ontario Medical Association. Toronto,
Bay 11, 1972.
- Clinical Dream Interpretation in the Light of Modern Sleep Research.
Ontario Psychiatric Association, Huntsville, September 30, 1972.
1973: - (with R. Melzack, R. Nelson and E. Peterson):
Current Concepts of Pain Mechanisms. Ottawa Neurosciences
Society, November 15, 1973
1974: - The Chronic Somatizer - Treatment Strategies. Maurice Levine
Society, University of Cincinnati, Cincinnati, Ohio,
October 12, 1974
1975: - Strategies in the Management of Chronic Pain. The Dr. F. R.
Eccles Memorial Lecture, University of Western Ontario,
London, February 5, 1975
- Psychiatric Aspects of Pain. Invited Lecture University of
Connecticut Health Centre, Department of Psychiatry, April
1976: - The Impact of Community Psychiatry on Psychiatric Teaching.
Association of Psychiatric Outpatient Centers of America,
Montreal, June 4, 1976
1977: - Issues in the Treatability of the Neuroses. Invited address,
Ontario Psychological Association, February 11, 1977
1978: - (with E.F Guirguis, H.B. Durost, J.T.D. Glaister, J.J. Jeffries
and G. Warme): The Use of Mechanical Restraints: Current Status.
Ontario Psychiatric Association, January 26, 1978
- A Reconsideration of Agoraphobia. Canadian Psychoanalytic
Society, Toronto, March 28, 1978
- Seldom Discussed Issues in Psychotherapy. Annual Meeting Canadian
Psychiatric Association, Halifax, October 18, 1978
1979: - Some Remarks on Epidemic Hysteria. Invited Lecture,
Cincinnati Psychiatric Society, Cincinnati, Ohio,
May 2, 1979
- (with S. Greben, R. Smith, P. Steinhauer and G. Voineskos):
The Psychiatric Training of Medical Students: Current Issues
and Future Directions. Annual Meeting, Canadian Psychiatric
Association, September 26, 1979
1980: - Psychotherapy for the 1980' s. Invited Address to the Annual Meeting,
Association of Psychiatric Outpatient Centers of America, June
1961i * (vith S. Ho6enbocu6, P. Leichner, H. Prosen and H. Kravits):
The Oral Certification Examination in Psychiatry. Annual
Meeting, Canadian Psychiatric Association, Winnipeg.
September 23, 1981
- (vith F.G. Sommers, J.D. Griffin, and R.O. Jones): Medical
and Psychological Effects of Nuclear War and the Nuclear Arms
Race. Annual Meeting, Canadian Psychiatric Association,
Winnipeg, September 24, 1981
- (vith J.M. Cleghorn and V.M. Rakoff): The Role of Psychoanalysis
in Contemporary Psychiatric Training. Annual Meeting, Canadian
Psychiatric Association, Winnipeg, September 25, 1981
1982: - The Use and Abuse of Drugs in the Treatment of Anxiety.
Saudi Arabian Annual Medical Meeting, King Faisal University,
Dammam, Saudi Arabia.
- (vith J.M. Cleghorn): P6ychodynamics in the Training of Psychiatric
Residents. Annual Meeting, American College of Psychoanalysts,
May 15, 1982
- Psychotherapy: A Personal View. Academy of Medicine, Toronto,
December 9, 1982
1983: - Psychotherapy and the Education of Psychiatrists.
Invited Lecture, Montreal General Hospital and McGill University
Department of Psychiatry. Montreal, April 15, 1983
- The Mission of the Physician: The Relationship of Science to
Har-an Values. The Edward Brooks Memorial Lecture, St. Michael' 6
Hospital, Toronto, June 23, 1983
- The Status of Psychotherapy Today. Invited Lecture, Department
of Psychiatry, University of Manitoba, Winnipeg, October
1984: The Impaired Physician: The Role of the Medical School. Annual
Meeting, The Royal College of Physicians & Surgeons, Montreal,
September 12, 1984
External Teaching and Lecturing
since coming to Toronto
University of Ottawa
University of Cincinnati
University of Western Ontario
University of Connecticut
St. Vincent's Hospital
National University of Ireland, Dublin
Memorial University of Newfoundland
University of British Columbia
University of Ottawa
University of Cincinnati
King Faisal University,
Dammam, Saudi Arabia
University of Manitoba
Beijing Hospital, Beijing China
Sichuan Medical College, Chengdu China
A. In Books
1972 1 Lowy, F.H. i The Psychology of Sleep - Some Current Issues.
In McClure, D.J. (Ed) First Canadian International Symposium
on Sleep: Proceedings April, 1972. Roche Scientific Service,
Hoffman - LaRoche, Vaudreuil, Quebec, 1972
1976s Lovy, F.H.s Delirium: Method of Treatment. In Current Therapy
837-839, Ed by H.G. Conn, Philadelphia: W.B. Saunders 6i Co. 1976
1977: Lovy, F.H.: Management of a Persistent Somatizer. Psychosomatic
Medicine Z.J. Lipowski, D.R. Lipsitt, P.C. Whybrow (Ed6>
New York: Oxford University Press, 1977
1978: Lovy, F.H. : The Impact of Community Psychiatry on Psychiatric
Teaching. In J.M. Divic and M. Dinoff (eds) Community Psychiatry
- Review and Preview University of Alabama Press
1978: Lovy, F.H.: Case Discu66ion, in H. Davanloo (Ed)
Basic Principles and Techniques in Short-Term Dynamic Psychotherapy
Jamaica, N.Y. : Spectrum Publications, 1978
1979: Lovy, F.H.: The Pendulum Swings from Society to the Individual,
in D.K. Weisstub (Ed) Law and Psychiatry II , New York:
1979: Lowy, F.H.: Full Cycle in Child Mental Health. In S.J. Shamsie
(ed) New Directions in Children* s Mental Health Jamaica N.Y.:
Spectrum Publications, 1979
1980: Lowy, F.H.: The Use of Drugs and Other Treatments in Depression
in F.J. Ayd (Ed) Clinical Depressions: Diagnostic and Therapeutic
Challenges , 1980
1980: Greben, S.E., Pos , R. , Rakoff, V., Bonkalo, A., Lowy, F.H., and
Voineskos, G. (Eds) A Method of Psychiatry Philadelphia:
Lea & Febiger, 1980 375 pages.
1980: Voineskos, G. and Lowy, F.H.: Psychiatric Emergencies. In S.E.
Greben et al. A Method of Psychiatry pp 267-274
1980: Voinesko6 G. and Lovy, F.H.: Suicide and Attempted Suicide.
In S.E. Greben et al. A Method of Psychiatry pp 275-280
1980: Lovy, F.H.: Psychiatric Treatment: General. In S.E. Greben et al.
A Method of Psychiatry pp 281-288
1980: Lovy, F.H. and Po6 , R.: Psychotherapy and Behavior Therapy,
In S.E. Greben et al. A Method of Psychiatry , pp 289-296
I960: Lovy, F.H.: Referral to the Psychiatrist. In S.E. Greben et al.
A Method of Psychiatry , pp 339-344
1984: Lovy , F.H.: Treatment of the Anxiety Disorders, Somatoform
Disorders, Dissociative Disorders and Personality Disorders.
In Endler, N.S. and Hunt H. McV. Personality and Behaviour
Disorders , 2nd Edition New York: John Wiley & Sons, 1984
1984: Lovy, F.H. : Anorexia Nervosa: a paradigm for mind-body
interdependence? In Darby, P.L., Garfinkel, P.E., Garner, D.M.,
and Coscina, D.V. (Eds) Anorexia Nervosa: Recent Developments
in Research , New York: Allan R. Liss 1984.
1985: Voineskos, G. and Lovy, F.H. : Psychiatric Emergencies in Greben,
S.E. , Rakoff, V.M. and Voineskos, G. A Method of Psychiatry, 2nd
Edition , Philadelphia: Lea & Febiger, 1985
1985: Voineskos, G. and Lowy, F.H. Suicide and Attempted Suicide, in
Greben, S.E., Rakoff, V.M. and Voineskos, G. A Method of Psychiatry,
2nd Edition , Philadelphia: Lea & Febiger, 1985.
1985: Lovy, F.H. : Referral to the Psychiatrist. In Greben, S.E., Rakoff,
V.M. and Voineskos, G. A Method of Psychiatry, 2nd Edition , Philadelphia:
Lea & Febiger, 1985.
B. In Refereed Journals
1957: Lambert, W.E. and Lovy, F.H.: Effects of the Presence and
Discussion of Others on Expressed Attitudes.
Canadian Psychol. II: 151-163, 1957
1964: Wylie, H.W. Jr., Lazoroff, P. and Lovy, F.H.: A Dying Patient
in a Psychotherapy Group. Internat. J. Group Psychother.
14: 482-490, 1964
1965: Lovy, F.H. : The Neuropsychiatric Complications of Viral Hepatitis,
Canad. Med. Assoc J. 92: 237-239, 1965.
1969: Lovy, F.H. , Wintrob, R.M. and Dhindsa, B.K.: Psychiatric
Emergencies at Expo '67, Canada. Psychiat. Assoc. J.
14: 47-52, 1969
1969: Lovy, F.H. , Wintrob, R.M. and Dhindsa, B.K.: Man and his
Anxiety. Laval Medical 40: 966-970, 1969
1970: Lovy, F.H., Recent Sleep and Dream Research: Clinical Implications
Canadian Medical Assoc. J. 102: 1069-1077, 1970
1970: Lovy, F.H. : Sleep Research and Scientific Change. Canadian
Med. Assoc. J. 102: 1105-1106, 1970 (unsigned editorial)
1970: Kinch, R.A.H., Lewis, D.J., Lovy, F.H. , MacDonald, R.N. and
Scriver, M.D.: The Teaching of Behaviour, Growth and Development
in the Preclinical Years of Medicine. Laval Medical 41:
495-499, 1970. Also published in Milbank Memorial Fund
Quarterly 49: 228-243 (April) 1970
1970: Lovy, F.H.: The Abuse of Abreaction: An Unhappy Legacy of
Freud's Cathartic Method. Canad. Psychiat. Assoc J. 15:
1970: Levis, D.J. and Lovy, F.H.: The Well-Tempered Psychiatrist:
Robert Allan Cleghorn, M.D. Canad. Psychiat. Assoc. J. 15: 513-514,
1971: Lovy, F.H. , Wintrob, R.M. , Borvick, B., Garmaise, G. and King,
H.O. : A Follow-up Study of Emergency Psychiatric Patients and
their Families: Methodological Problems. Comprehensive Psychiat.
12* 36-47, 1971
1971: Lovy, F.H.: Lessons from Emergencies: Canad. Psychiat. Assoc. J.
16: 103-104, 1971
- 13 -
1971s Lovy, F.H., Cleghorn, J.M. and McClure, D.J.: Sleep Patterns
in Depression. J. Nerv. Ment. Pis. 153: 10-26, 1971
1971: Levy, F.H.: New Directions in Dream Psychology Research
Canad. Psychlat. Assoc. J. 16: 399-406, 1971
1971: Lovy, F.H. and Kolivakis, T.K.: Autocastration by a Male
Transsexual. Canadian Psychiat. Assoc. J, 16: 399-406, 1971
1971: Cleghorn, R.A. , Cleghorn, J.M. and Lovy F.H.: Contributions
of behavioural Sciences to Health Care.
Milbank Memorial Fund Quart. 49: 158-174, 1971
1973: Lovy, F.H. , Engelsmann, F. and Lipovski, Z.J.: Study of Cognitive
Functioning in a Medical Population.
Comprehensive Psychiatry, 14: 331-337, 1973
1973: Lovy, F.H. : Psychiatric Research. Canad. Psychiat. Assoc. J.
18: 91-92, 1973
1974: Lovy, F.H.: Renaissance of Psychiatric Diagnosis.
Canad. Psychiat. Assoc. J. 19: 233-254, 1974
1975: Lowy, F.H. : Editorial: Clarence B. Farrar, 1874-1970, and the
History of Psychiatry in Canada. Canad. Psychiat. Assoc. J.
20: 1-2, 1975
1975: Lowy, F.H.: Management of the Persistent Somatizer.
International Journal of Psychiatry in Medicine
6: 227-239, 1975
1976: Lowy, F.H.: The State of the Specialty. Canad. Psychiat. Assoc.
J^ 21: 504-505, 1976
1979: Lowy, F.H. and Jones R.O.: The Canadian Certification Examination
in Psychiatry I - Historical Notes. Canad. J. Psychiatry
24: (4), 1979
1979: Lowy, F.H. and Dongier, M. : The Canadian Certification Examination
in Psychiatry II - Who Passes and Who Fails. Canad. J. Psychiatry
24: (4) 1979
1979: Lowy, F.H. and Prosen, H. : The Canadian Certification in
Psychiatry III - Towards Better Certification Techniques
Canad. J. Psychiatry 24: (4) 1979
1980: Lowy, F.H. and Thornton, J. : To be or not to be a psychiatric chief
resident: Factors in Selection. Canad. J. Psychiatry
25: 121-126, 1980
1981 1 Ban, T.A., Brown, W.T., Da Silva, T. , Gagnon, M. , Lamond, C.T.,
LcbaAnn , H *E • , Lowy , F • H • , Rutdy , J » , S® 1 lcn , £ «M* i Canad . Me d .
Aaaoc . J. 124: 1439-1446, 1981
1981 1 Lipptnann, D.H., Lowy, F.H., and Rickhi, B.i Attitudes of Ontario
Psychiatrists towards health insurance. Canad. Med. Assoc. J.
125: 167-170, 1980
1981: Voineskos, G., Greben, S.E., Lowy, F.H., Smith, F.L., and Steinhauer,
P.D. : The psychiatric training of medical students. Canad. J. Psychiatry
26: 301-308, 1981
1984: Roacarl, D.A.K., Salter, R.B., Till, J.R., and Lowy, F.H.:
Is the clinician-scientist really vanishing? Encouraging results
from a Canadian institute of medical science, Canad. Med. Assoc.
J. 130: 977-979, 1984
C. In Other Journals and Periodicals
1972i Lovy , F.H.: The Psychiatrist-Physician Relationship in General
Hospitals: Present and Future. Ontario Medical Review , 727-732,
1975: Berg, J.M., Lovy, F.H.: XYY Syndrome: A comment. Modern Medicine
of Canada . 30: 8, 692-693, August, 1975
1979: Editorial Board - A Resident's Guide to Psychiatric Education
M.G.G. Thompson (Ed) New York: Plenum Publishing, 1979
1979: Lovy, F.H.: The Neurosciences at the Clarke Institute of Psychiatry.
Trends in Neuroscience. 2: X-XI , October, 1979
1981: Lovy, F.H.: The Future Physician: Labyrinth of Expectations.
The Medical Graduate 26: 5-7, 1981
1981: Lovy, F.H.: The Dean's Challenge. University of Toronto Medical
Journal , January 1982. pp 34-37
1982: Lovy, F.H.: The Alumni and the Faculty: Why Support Human
Nutrition. The Medical Graduate 27: 4-5, 1982
1982: Lovy, F.H.: Preventing the Ultimate Epidemic, Re: Action
(Canad. Mental Health Assoc.) Fall, 1982
1983: Lovy, F.H.: Psychotherapy in the 1980's POCA Press: 15: 13-19,
1983 (Psychiatric Outpatient Centres of America)
1983: Lovy, F.H.: The Faculty looks to the Alumni, The Medical Graduate
28, 4-5, 1983
1984: Lovy, F.H.: Tovards Better Communication, Tablet (Fac. of Med,
U. of T.) 1, 1-2, 1984
1985: Lovy, F.H. On Communication and Research, Tablet (Fac. of Med,
U. of T.) Vol 1, No. 2, p 3
1985: Lovy, F.H. From Competence to the Pursuit of Excellence, Tablet
(Faculty of Medicine, University of Toronto Vol 1, No. 3, p 2.
Lovy, F.H. The 1985 Noble Peace Prize, Tablet (Faculty of Medicine,
University of Toronto) Vol 1, No. 4, P 2.